化疗引起的周围神经病与化疗癌症幸存者执行功能下降的关联：一项横断面研究。

The association of chemotherapy-induced peripheral neuropathy with reduced executive function in chemotherapy-treated cancer survivors: A cross-sectional study.

机构信息

Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.

University of Vermont Cancer Center, Burlington, VT, USA; Department of Medicine, University of Vermont, Burlington, VT, USA.

出版信息

J Geriatr Oncol. 2024 May;15(4):101765. doi: 10.1016/j.jgo.2024.101765. Epub 2024 Apr 5.

DOI:10.1016/j.jgo.2024.101765

PMID:38581957

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11088516/

Abstract

INTRODUCTION

Chemotherapy-induced peripheral neuropathy (CIPN) is common and disabling among cancer survivors. Little is known about the association of CIPN with other measures of the nervous system's integrity, such as executive dysfunction. We compared measures of executive function in older chemotherapy-treated cancer survivors with and without CIPN.

MATERIALS AND METHODS

This cross-sectional study enrolled 50 chemotherapy-treated cancer survivors (65.6 ± 11.5 years, 88% female) post-chemotherapy treatment who were previously referred for outpatient rehabilitation at the request of the cancer survivor or a medical provider. Twenty-two participants (44%) had CIPN defined by patient-reported distal paresthesia or numbness, which began with chemotherapy and continued to the time of cognitive testing. Measures of executive function included Trails-B, Stroop, and rapid reaction accuracy (RRA) and were evaluated between cancer survivors with and without CIPN using t-tests. Multivariable models were then used to determine whether CIPN was an independent determinant of the measures of executive function (Trails-B, Stroop Incongruent, and RRA). Models were adjusted for age, sex, history of anxiety, and benzodiazepine use due to their known associations with CIPN and executive function.

RESULTS

Cancer survivors with CIPN (CIPN+) had reduced executive function compared to survivors without CIPN (CIPN-) on Trails-B (CIPN+: 84.9 s ± 44.1 s, CIPN-: 59.1 s ± 22.5 s, p = 0.01), Stroop (CIPN+: 100.6 s ± 38.2 s, CIPN-: 82.1 s ± 17.3 s, p = 0.03), and RRA (CIPN+: 60.3% ± 12.9%, CIPN-: 70.6% ± 15.7%, p = 0.01). There were no differences in cancer stage severity or functional status by patient report or sit-to-stand function. The association between CIPN and reduced executive function was found in multivariable models after adjusting for age, sex, anxiety, and benzodiazepine use for Trails-B (ß:17.9, p = 0.046), Stroop (ß:16.9, p = 0.02), and RRA (ß:-0.072, p = 0.03).

DISCUSSION

In this population, CIPN is associated with reduced executive function in older cancer survivors treated with chemotherapy. Future research is required to further understand this preliminary association, the causality, and the potential risk factors.

摘要

简介

化疗引起的周围神经病（CIPN）在癌症幸存者中很常见且具有致残性。人们对 CIPN 与神经系统完整性的其他测量指标（如执行功能障碍）之间的关联知之甚少。我们比较了患有和不患有 CIPN 的老年化疗癌症幸存者的执行功能测量值。

材料和方法

这项横断面研究纳入了 50 名化疗后癌症幸存者（65.6±11.5 岁，88%为女性），他们在化疗后曾因癌症幸存者或医疗服务提供者的要求到门诊康复机构就诊。22 名参与者（44%）患有 CIPN，定义为患者报告的远端感觉异常或麻木，这种情况始于化疗，并持续到认知测试时。执行功能的测量包括 Trails-B、Stroop 和快速反应准确性（RRA），并使用 t 检验比较有和无 CIPN 的癌症幸存者之间的这些测量值。然后使用多变量模型来确定 CIPN 是否是执行功能（Trails-B、Stroop 不一致和 RRA）测量值的独立决定因素。由于已知 CIPN 和执行功能与年龄、性别、焦虑史和苯二氮䓬类药物的使用有关，因此模型调整了这些因素。

结果

与没有 CIPN（CIPN-）的幸存者相比，患有 CIPN（CIPN+）的癌症幸存者在 Trails-B（CIPN+：84.9±44.1s，CIPN-：59.1±22.5s，p=0.01）、Stroop（CIPN+：100.6±38.2s，CIPN-：82.1±17.3s，p=0.03）和 RRA（CIPN+：60.3%±12.9%，CIPN-：70.6%±15.7%，p=0.01）方面的执行功能更差。通过患者报告或从坐位到站位功能，没有发现癌症阶段严重程度或功能状态的差异。在调整年龄、性别、焦虑和苯二氮䓬类药物使用后，多变量模型发现 CIPN 与执行功能下降之间存在关联，Trails-B（β：17.9，p=0.046）、Stroop（β：16.9，p=0.02）和 RRA（β：-0.072，p=0.03）。