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Chemotherapy can induce verbal and visuospatial impairments long-term

MD-FM Thursday October 11, 2012

Sarah :
MD FM — Medical News from around the the world with Peter Goodwin

PETER: Hello, and to begin with: in breast cancer survivors, cognitive impairments induced by chemotherapy --also known as chemofog --can persist long after treatment completion...

SARAH: Yes, researchers found that breast cancer survivor who had undergone chemotherapy suffered long-term impairments, but in two domains only:
-in verbal abilities, particularly in the ability to find words
-and in visuaospatial functions, for instance they got lost more easily in an unfamiliar location than those who had never had chemo.
Overall, these deficits tended to be mild:

Bob JIM: “Practitioners can educate patients that, at least on average, six month or more after treatment, the cognitive problems tend to be pretty slight. But again there may be people who are suffering greater impairments and if so they should really be referred to a neuro-psychologist for a follow up and for management. There are several studies ongoing to look at different nutritional supplements to see if those help cognition, pharmaceutical interventions to see if those are helpful, behavioral interventions to see if we can train people to compensate for the deficits that they are experiencing...”

SARAH: That was Heather Jim, from the Moffitt Cancer Center in Florida, lead author of the study in the Journal of Clinical Oncology. She said research is also ongoing to identify which subgroups might be more at risks for severe cognitive impairments.

BOB JIM: “We’re not really sure why some people seem to be affected more than others. There are a lot of different ideas right now --we are looking at genetic vulnerabilities, certainly older age is associated with greater problems in cognitive functioning after chemotherapy, and also less education.”

SARAH: Dr. Jim, from Florida, led this first meta-analysis, reviewing all data on breast cancer patients at least 6 months after chemotherapy and up to 10 years later in some cases. She cautioned that these results should not be generalized to other types of cancer survivors, on whom data is still insufficient.

PETER: Other findings suggest that long-term survivors of childhood Hodgkin’s lymphoma are also at risk for neurocognitive impairment: In another JCO study, 62 adult survivors had lower performance than controls in: sustained attention, short-term memory, long-term memory, working memory, naming speed and cognitive fluency. These deficits were linked to reduced brain integrity on MRI: More than half of these participants had developed leukoencephalopathy.


PETER: Maternal depression AND the use of antidepressants can both alter a crucial period of language development in babies…

SARAH: Yes, maternal depression, when untreated by serotonin reuptake inhibitors, was shown to prolong the period of language development in babies, sometimes by several months. On the contrary: the use of SRI in depressed mothers accelerated the aquisition development in their babies!

PETER: This period typically takes place according to a very tight maturational schedule… so it doesnt sound right to accelerate or slow it down. Did they look at the consequences?

SARAH: Listen to the lead author of the PNAS study: Pr. Janet Werker, from the University of British Colombia, in Vancouver:

Bob-Werker: “We don’t know if when timing gets disrupted by maternal depression or SRI exposure, if it’s going to affect development. There is a hint in the literature that this could have long term consequences but with these particular populations there could be self correcting processes that go on.”

SARAH: And these are her hypotheses as to what might be going on:

Bob Werker 2: “The effect of SRIs is clearly one of the pharmacological exposure. The effect of maternal depression could be the downstream consequences of the hormonal changes that happen with maternal depression, or it could be that the moms who are depressed are not interacting with their babies in as engaging a fashion and so it’s kind of akin to dark rearing in the visual system”

SARAH: Pr. Werker said her team now intends to study the long term consequences of such changes, and the effects of other antidepressants.

PETER: General practitioners should be given a greater role in excluding pulmonary embolism diagnosis, to help reduce the high rates of unnecessary hospital referrals..

SARAH: This is what researchers concluded after showing that GP safely and efficiently excluded pulmonary embolism when provided with evaluation tools that are currently only used in hospitals.

PETER: Yes in practice, GPs usually refer all potential cases to the hospital. So what tools did they use in this trial?

SARAH: It was combination: The Wells clinical decision rule, which separates patients at high probability from those at low probability of pulmonary embolism. And the qualitative D-dimer test kit, which enables to safely exclude pulmonary embolism when negative. 300 GPs evaluated nearly 600 patients with potential symptoms using those two tests. Their diagnosis was then confirmed or refuted by secondary care reference testing, which revealed that only 1.5% of cases excluded were false negatives.

Bob-Geersing: “We argue that that is a safe proportion of missed pulmonary embolism events. Also because the most commonly used reference standard nowadays, which is spiral computed tomography scan, also misses a small proportion of pulmonary embolisms. So we argue that when you can do as good as the spiral CT scan, then you are safe.”

SARAH: This was lead author of the BMJ study, Dr. Geert-Jan Geersing, from the University of Utrecht in the Netherland. More research is needed to confirm these findings.


PETER: In children with hemophilia, “vigorous” sports do not appear to increase the absolute risk of bleeding…

SARAH: Yes, this is despite the fact that they do increase the risks of bleeding during the activity period, compared to doing nothing: there was a 3-fold increased risk of bleeding in children performing sports like basketball, in which collisions are expected to occur, and a 4-fold increased risk when performing sports like wrestling or rugby –in which collisions are inevitable.

Bob-Broderick-1: “In some ways it’s reassuring for parents because even though the risk is moderate, it’s so transient. If you look at kids over a period of a year, even those who are reasonably active in sports, there’s much more time spent in the inactive state --sleeping, eating, playing computer games, watching TV... so physical activity does not contribute much to the absolute risk of bleeding over a period of a year.”

SARAH: That was Carolyn Broderick, from the University of Sydney in Australia, who led the JAMA study. She said clotting factor blood levels are more important in determining the absolute risks of bleeding.

Bob-Broderick-2: “Clotting factor injections reduce the risks. So we would advice people, before they do vigorous physical activity, to give themselves clotting factor injections. Obviously --when that’s available”

SARAH: Dr. Broderick from Australia, who added that while these children should not be discouraged from engaging in vigorous sports, it is wise to keep them away from extreme activities, such as boxing, in which the risk of trauma to vital organs is such that consequences of bleeds would be catastrophic.

BREVE 1 Sur fond musical
PETER: Finally, in brief: People with AIDS are at increased risk of developing esophageal and stomach carcinomas, as well as non-Hodgkin-lymphomas. These are the conclusions of a study published in Gastroenterology, in which researchers looked at nearly 30-years-worth of data from various registries in the US to compare risk of such malignancies among people with AIDS and in the general population.

And …..
Elevated plasma levels of proneurotensin --a precursor of the hormone neurotensin --may be a marker of underlying cardiometabolic disease or breast cancer susceptibility in women. In a new JAMA study, researchers measured proneurotensin levels in over 4500 participants, whom they followed for up to 16 years. Elevated proneurotensin levelswere associated with increased risks of diabetes, cardiovascular disease, breast cancer and death in women.

That's all from MDFM for now. We'll be back next week


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