Assessment and Management of Cancer- and Cancer Treatment–Related Cognitive Impairment

Cognitive impairment resulting from cancer and subsequent treatment is one of the most common and troubling sequelae experienced by cancer survivors. Cancer survivors report that cognitive impairment negatively affects their quality of life. Appropriate assessment and management of cognitive impairment is critical to providing optimal care to cancer survivors. The purpose of this article is to briefly describe the state of evidence on incidence, possible mechanisms, and presentation of cancer- and cancer treatment–related cognitive impairment and to provide guidance for its assessment and management. We focus on management with nonpharmacological and pharmacological interventions that may have clinical utility.     

A CLIMATE: A Tool for Assessment of Climate-Change–Related Health Consequences in the Emergency Department

Climate change is an urgent public health problem that has looming implications and associated deleterious health consequences. The intersection of climate change and health has broad implications for health professionals in a variety of settings but especially for ED settings. Climate change is already affecting human health and health systems—which includes impacts on ED care. Disaster response and emergency preparedness are critically important public health interventions in our climate-changing world, and the contributions of emergency nurses are essential. Disaster preparedness, environmental emergency response, and health emergency management are important elements of emergency nursing and are explicated in Sheehy’s Emergency Nursing Principles and Practices, 7th Edition. The purpose of this article is to present an overview of a clinical tool and mnemonic, A CLIMATE, developed by the authors with application to a case review. It is imperative that the nursing profession—particularly emergency clinicians—address the intersection of climate and health to engage in the assessment, intervention, management, evaluation, education, and referral of those who present to emergency departments with potential climate-related health impacts.     

Point-of-Care Ultrasound—A New Option for Early Quantitative Assessment of Pulmonary Edema

The aim of the work described here was to investigate the value of point-of-care ultrasound (POCUS) in the early assessment of the severity of pulmonary edema in rabbits. A rabbit oleic acid (OA)-induced pulmonary edema model was used. Thirty-two New Zealand rabbits were randomly divided into four groups: a control group and three pulmonary edema groups (mild, moderate and severe). Features of transthoracic B-line artifacts (BLA), blood pH, PaO₂ and PaCO₂, serum inflammatory factors, lung coefficient (LC), lung wet-to-dry weight ratio (W/D) and lung histopathology were assessed. BLA features and severity of pulmonary edema were semiquantitatively scored. Correlations between the number of BLA and PaO₂, PaCO₂, serum inflammatory factors, LC and W/D were analyzed. An additional 8 rabbits with severe pulmonary edema were used as the verified group, in which the lung was divided into ex vivo BLA (BLA-ev)-free (BLA-ev-free) and BLA-ev-clustered subregions depending on the features of BLA-ev recorded by ex vivo lung ultrasound. Lung specimens from each subregion were collected for histopathological examination. Relationships between features of BLA-ev and lung histopathological abnormalities were analyzed. With increasing doses of OA, number of BLA, W/D and levels of serum inflammatory factors decreased. Meanwhile, lung pathologic abnormalities were aggravated. In addition, time of appearance of BLA, blood pH and PaO_2, and PaCO₂ decreased dose dependently on OA (p < 0.05). Number of BLA was linear positively correlated with severity of pulmonary edema (r = 0.953, p < 0.05). Consistently, the features of BLA-ev reflected the severity of lung histopathological abnormalities (r = 0.936, p < 0.05). Thus, POCUS is useful in the early quantitative assessment of the severity of pulmonary edema.     

Is Early Detection of Ovarian Cancer Possible?

Advances in medical technology have led to potentially useful techniques for the early detection of epithelial ovarian cancer. Early detection of ovarian cancer is crucial for survival as women found to have Stage I or II disease have a 5-year survival of 90% and 70%, respectively, whereas those with advanced disease (Stage III and IV) have a survival of approximately 20%. The circulating tumour marker CA-125 has been extremely useful in following women known to have epithelial ovarian cancers. It has been employed in differentiating benign tumours from malignancies, and is now being tested in a variety of programmes for its role in the early detection of ovarian cancer. The application of endovaginal ultrasound and colour Doppler flow techniques to early detection of ovarian cancer have resulted in several large series identifying ovarian cancer in 1: 1000 to 1: 2000 postmenopausal women screened. However, a high false positivity rate persists using CA-125 and ultrasound techniques alone or in sequence. Developments in molecular genetics may be extremely useful in evaluating women with inherited susceptibilities for this disease, but this probably represents only about 3% of the population of the women who develop epithelial ovarian cancer. The cost-benefit analysis of isolated screening for epithelial ovarian cancer using CA-125 and ultrasound techniques, even in women at high risk for the disease, would suggest that such screening is not cost-effective at this time.     

Added Value of Quantitative Ultrasound and Machine Learning in BI-RADS 4–5 Assessment of Solid Breast Lesions

The purpose of this study was to evaluate various combinations of 13 features based on shear wave elasticity (SWE), statistical and spectral backscatter properties of tissues, along with the Breast Imaging Reporting and Data System (BI-RADS), for classification of solid breast lesions at ultrasonography by means of random forests. One hundred and three women with 103 suspicious solid breast lesions (BI-RADS categories 4-5) were enrolled. Before biopsy, additional SWE images and a cine sequence of ultrasound images were obtained. The contours of lesions were delineated, and parametric maps of the homodyned-K distribution were computed on three regions: intra-tumoral, supra-tumoral and infra-tumoral zones. Maximum elasticity and total attenuation coefficient were also extracted. Random forests yielded receiver operating characteristic (ROC) curves for various combinations of features. Adding BI-RADS category improved the classification performance of other features. The best result was an area under the ROC curve of 0.97, with 75.9% specificity at 98% sensitivity.     

French version of the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog) version 3

Purpose

Impairment of cognitive function, a common complaint in patients receiving chemotherapy, is usually measured through neuropsychological tests. Patient self-evaluation of cognitive difficulties is an important complement to those tests. The Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog) is a self-report questionnaire with potential to be used in standard clinical practice as a tool for evaluating patient's cognitive function before, during, and after chemotherapy. The purpose of our study was to conduct linguistic validation of the French version of the FACT-Cog.

Methods

Both qualitative and quantitative methods were used in this study. After undergoing a rigorous translation methodology, the French FACT-Cog version was pretested in France with 35 cancer patients undergoing chemotherapy treatment. Interviews were conducted with all patients to ascertain their understanding of each item. The validation of the final version was conducted among 63 cancer patients, and sociodemographic information was collected as well as brief measure of cognitive function and depression score.

Results

Patient comments obtained through the cognitive debriefing interviews indicated that patients understand the French FACT-Cog items as they are intended and that the measure is culturally appropriate. Internal consistency reliability of the subscales, evaluated using Cronbach's coefficient alpha, was high for all four subscales: Perceived Cognitive Impairments?=?0.93, Impact On QOL?=?0.85, Comments From Others?=?0.70, and Perceived Cognitive Abilities?=?0.89. All item-total correlations for each subscale were greater than 0.20, and most were greater than 0.50.

Conclusions

Results from this study effectively demonstrate that the French FACT-Cog is a reliable instrument for the self-reporting of cognitive abilities in patients undergoing chemotherapy.     

Measurement Properties of the Eight-Item Abbreviated Functional Assessment of Cancer Therapy—Breast Symptom Index and Comparison With Its 37-Item Parent Measure

ContextThe Functional Assessment of Cancer Therapy—Breast Symptom Index (FBSI) is an eight-item instrument extracted from the Functional Assessment of Cancer Therapy—Breast (FACT-B). There has been no formal assessment of this eight-item version.ObjectivesThis study aimed to examine the measurement properties of and comparability between the English and the Chinese versions of the FBSI and to compare it with its parent instrument, the FACT-B, in breast cancer patients in Singapore.MethodsThis was an observational study of 271 breast cancer patients. Known-group validity of FBSI scores was assessed using four health indicators. Convergent and divergent validity was examined by correlation coefficients between the FBSI and the FACT-B. Responsiveness was assessed in relation to longitudinal changes in performance status. Test-retest reliability was evaluated by the intraclass correlation coefficient. Multiple regression analyses were performed to compare the scores on the two language versions. Receiver operating characteristic curve analyses were used for comparison between the FBSI and the FACT-B.ResultsFor both language versions, the FBSI demonstrated known-group validity, convergent and divergent validity, and sufficient test-retest reliability (intraclass correlation coefficient = 0.75–0.77). The English version was responsive to changes in performance status. The Chinese version was responsive to decline in performance status, but there was no conclusive evidence about its responsiveness to improvement in performance status. No practical significant difference was found in the outcomes between the two language versions despite minor difference in one item. The FBSI performed comparably with the FACT-B.ConclusionThe English and Chinese versions of the FBSI are valid and reliable and provide comparable FBSI scores. The English version is responsive to change, whereas the responsiveness of the Chinese version warrants further study.     

Suboptimal Duration of Granulocyte Colony–stimulating Factor Use and Chemotherapy-induced Neutropenia in Women Diagnosed With Breast Cancer

Purpose

Prophylactic use of granulocyte colony–stimulating factor (G-CSF) is recommended for cancer patients who are at high risk of neutropenic events. However, whether the clinical effectiveness of G-CSF from randomized controlled trials translates into “real-world” clinical practice is questionable. The goal of this retrospective cohort study was to examine the impact of G-CSF prophylaxis and other potential risk factors of severe neutropenia in women with breast cancer.

Methods

Our study subjects were women who were diagnosed with breast cancer and who received a new course of chemotherapy between January 1, 2010, and December 31, 2010, at a cancer center in Taiwan. Generalized estimating equations were applied to examine the association between G-CSF prophylaxis and neutropenic events.

Findings

We identified 353 women with breast cancer who received a total of 2776 cycles of chemotherapy. G-CSF was used as primary prophylaxis in 7% (n = 202) of cycles and as secondary prophylaxis in 11% (n = 319) of cycles. The mean duration of G-CSF for primary and secondary prophylaxis was 4.9 and 3.7 days, respectively. A chemotherapy regimen with high risk of febrile neutropenia was found to be a risk factor for severe neutropenic events (odds ratio, 3.22 [95% CI, 1.97–5.27]). Prophylactic use of G-CSF was not statistically significantly associated with febrile neutropenia.

Implications

The major determinants of neutropenic events among patients with breast cancer were the content and intensity of chemotherapy regimens. Suboptimal use of G-CSF may not be effective in preventing neutropenic events among women with breast cancer.     

Prevention and exercise therapy of osteoporosis for older population

INTRODUCTIONOsteoporosisofolderpopulationsisknownasretrogressiveosteo－porosiswhichistheresultofagingofbonesandbelongstothepri－maryosteoporosisII．Withthepassoftime，reductionofmaterialandmatrixofbones，bonebecomesthin，decreaseofnumberofbonetrabecula，risksoffractureandfragilitywillincrease．PREVENTIONOFOSTEOPOROSISINOLDERPOPULA－TIONDietpreventionFoodsourceofcalciumandphosphorusMildproductsisthemostampleincalcium．Somegreensandfishisalsoampleincal－cium．Thefollowingi…     

Reliability and validity of the Functional Assessment of Chronic Illness Therapy–Spiritual (FACIT–Sp) for Japanese patients with cancer

The reliability and validity of the Japanese version of the Functional Assessment of Chronic Illness Therapy–Spiritual (FACIT–Sp) scale were assessed. This scale was developed in the United States to assess quality of life (QOL) in relation to spirituality. Two surveys were conducted on each of 306 cancer patients. In addition to the FACIT–Sp, the Hospital Anxiety and Depression Scale (HADS) was administered. Cronbachs alpha reliability coefficient, an evaluation of internal consistency, for the FACIT–Sp subscales ranged from 0.81 to 0.91. There were no significant differences between the patients evaluated using the FACIT–Sp subscale and the HADS subscale with regard to degree of religious feelings. The correlation coefficients between the FACIT–Sp and the HADS depression and anxiety scales indicated a moderate correlation. These findings suggest that the Japanese version of the FACIT–Sp scale is satisfactory in terms of reliability and validity and is a useful tool in the study of spirituality among Japanese cancer patients.     

Which quality of life instruments are preferred by cancer patients in Japan? Comparison of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and the Functional Assessment of Cancer Therapy-General

Purpose

We compared two health-related quality of life (HRQOL) instruments used for cancer patients [the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy-General (FACT-G)] to identify which instrument cancer patients most preferred.

Methods

Adult cancer patients who had received cancer treatments within the previous 2 years (n?=?395) completed both surveys; participants assessed the importance, necessity, and appropriateness of each as an indicator of their quality of life.

Results

The patients significantly preferred the FACT-G over the EORTC QLQ-C30 as a more important (effect size (ES)?=?0.37, P?P?P?=?0.005). The subgroups of patients with good performance status, and those who reported low levels of work disruption, significantly preferred the FACT-G more than the other. The corresponding correlation coefficients were the following: physical functioning and well-being subscale, r?=?0.65; emotional functioning and well-being subscale, r?=?0.60; social functioning and social/family well-being subscale, r?=?0.00; and role functioning and functional well-being subscale, r?=?0.41.

Conclusions

We recommend using the FACT-G if the performance status of the subject is good, e.g., in outpatient or cancer survivor surveys, based on the observed patient preferences. When performance status is not good, an instrument should be chosen after considering the differences between their scale structures and social domains and based on the availability of disease-specific modules.     

Are Psychological Predictors of Chronic Postsurgical Pain Dependent on the Surgical Model? A Comparison of Total Knee Arthroplasty and Breast Surgery for Cancer

Anxiety, depression, and catastrophizing are generally considered to be predictive of chronic postoperative pain, but this may not be the case after all types of surgery, raising the possibility that the results depend on the surgical model. We assessed the predictive value of these factors for chronic postsurgical pain in 2 different surgical models: total knee arthroplasty for osteoarthritis (89 patients, 65% women, age = 69 ± 9 years, baseline pain intensity = 4.7 ± 2.1) and breast surgery for cancer (100 patients, 100% women, age = 55 ± 12 years, no preoperative pain). Data were collected before surgery, then 2 days and 3 months after surgery. Anxiety, depression, and catastrophizing were measured with the Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale, respectively. Pain was assessed with the Brief Pain Inventory. Neuropathic pain was detected with the DN4 questionnaire. Multivariate logistic regression analyses for the total knee arthroplasty and breast surgery models considered together indicated that the presence of clinically meaningful chronic pain at 3 months (pain intensity ≥3/10) was predicted independently by age (P = .04), pain intensity on day 2 (P = .009), and state anxiety (P = .001). Linear regression models also showed that pain magnification, one of the dimensions of catastrophizing, independently predicted chronic pain intensity (P = .04). These results were not affected by the surgical model or by the neuropathic characteristics of the pain. Thus, state anxiety and pain magnification seem to constitute psychological risk factors for chronic postsurgical pain relevant in all surgical models.PerspectiveThis prospective study performed in patients with total knee arthroplasty or breast surgery for cancer shows that state anxiety, amplification of pain, and acute postoperative pain independently predict postsurgical pain at 3 months and that this does not depend on the surgical model.