Department of Clinical Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia.
University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2021 Oct;51(10):1665-1672. doi: 10.1111/imj.15204.
Chemotherapy-related cognitive impairment (CRCI) is a known adverse event that can impact cancer survivors, resulting in long-standing effect on quality of life and activities of daily living. Currently, there is limited knowledge regarding the aetiology and therapy for CRCI. Although CRCI following autologous stem cell transplantation (AuSCT) is emerging as a potentially significant concern for patients with underlying haematological malignancies, it is an area that requires further research.
This pilot study aimed to assess (i) the prevalence of CRCI in patients with haematological malignancies both pre-AuSCT and post-AuSCT and (ii) the feasibility of a cognitive rehabilitation programme (CRP) in survivorship care post-AuSCT.
Over a 12-month period, consecutive patients planned for AuSCT were approached for the study. Enrolled patients were administered a 9-week course of CRP, commencing day 40 ± 5 post-AuSCT. Participants were evaluated using a neuropsychological tool and validated questionnaires at baseline, pre-CRP (day 40 ± 5 post-AuSCT), post-CRP and 6 months post-CRP.
Thirty-two patients were enrolled. The mean age was 59 years (SD = 11.5), 23 (72%) were male and 18 (56%) had multiple myeloma. Participants reported high satisfaction using the CRP, and most devoted significant amount of time as requested.
While there appeared to be a low incidence of significant CRCI in our patient population, the incorporation of CRP in survivorship care appeared to be feasible. A larger randomised study examining the efficacy of CRP should be further explored.
化疗相关认知障碍（CRCI）是一种已知的不良反应，会影响癌症幸存者，对生活质量和日常生活活动产生长期影响。目前，对于 CRCI 的病因和治疗方法知之甚少。尽管自体干细胞移植（AuSCT）后出现的 CRCI 似乎是血液恶性肿瘤患者的一个潜在重大问题，但这是一个需要进一步研究的领域。
本研究旨在评估（i）血液恶性肿瘤患者在 AuSCT 前后发生 CRCI 的患病率，以及（ii）AuSCT 后生存护理中认知康复计划（CRP）的可行性。
在 12 个月的时间内，对计划接受 AuSCT 的连续患者进行了研究。入组患者接受了为期 9 周的 CRP 治疗，从 AuSCT 后第 40 ± 5 天开始。参与者在基线、CRP 前（AuSCT 后第 40 ± 5 天）、CRP 后和 CRP 后 6 个月使用神经心理学工具和经过验证的问卷进行评估。
共纳入 32 例患者。平均年龄为 59 岁（标准差=11.5），23 例（72%）为男性，18 例（56%）患有多发性骨髓瘤。患者对 CRP 的使用满意度较高，大多数人按要求投入了大量时间。
虽然我们的患者群体中似乎 CRCI 的发生率较低，但 CRP 纳入生存护理似乎是可行的。应进一步探讨一项更大规模的随机研究，以检验 CRP 的疗效。
