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Kanker dan chemobrain : diagnosis kanker mempengaruhi fungsi kognitif

Penderita kanker payudara sering menampilkan cacat kognitif ringan bahkan sebelum memulai kemoterapi . Sebuah studi baru ..... sindrom stres pasca-trauma yang disebabkan oleh diagnosis penyakit.....read more

Cancer and
chemobrain: Cancer diagnosis affects cognitive function

Date:

April 17, 2015

Source:

Ludwig-Maximilians-Universitaet
Muenchen (LMU)

Summary:

Breast cancer patients
often display mild cognitive defects even before the initiation of
chemotherapy. A new study now attributes the syndrome to post-traumatic stress
induced by diagnosis of the disease




......................

breast cancer patients
often display mild cognitive defects even before the initiation of
chemotherapy. A new study by Ludwig-Maximilians-Universitaet (LMU) in Munich
researchers now attributes the syndrome to post-traumatic stress induced by
diagnosis of the disease.

A large number of studies have shown that cancer patients very often
exhibit mild deficits of attention, memory and other basic cognitive functions.
The phenomenon has generally been attributed to putative side-effects of
chemotherapeutic drugs on the brain, and the condition is therefore popularly
referred to as chemobrain. -- However, more recent investigations have detected
symptoms of chemobrain in patients who had not yet embarked on a course of
chemotherapy. Now a research team led by LMU's Dr. Kerstin Hermelink at the
Breast Center in the Department of Gynecology and Obstetrics at Munich
University Hospital has shown that, in breast cancer patients, pretreatment
cognitive impairment is most probably due to posttraumatic stress induced by
diagnosis of the malignancy itself. The group's findings have just appeared in
the Journal of the National Cancer Institute.

Much of the published evidence for the appearance of pretreatment
perturbations of cognitive function has come from studies on breast cancer
patients, and several hypotheses have been advanced to account for these
findings. For example, it has been proposed that malignant disease might itself
disrupt certain brain functions by activating the secretion of cytokines that
modulate the immune system. An alternative suggestion is based on the idea that
cancer and cognitive impairment might have a common genetic basis. The latest
data come from a multicenter study called Cognicares (Cognition in Breast
Cancer Patients -- the Impact of Cancer-related Stress), in which the LMU
researchers have tested a quite different theory, for which their findings now
provide strong support.

Diagnosis-associated trauma

"Cancer patients can perceive and experience their condition as a
severe trauma. Indeed, many of them develop symptoms of post-traumatic stress
disorder, particularly in the early phase after they receive the
diagnosis," says Kerstin Hermelink. "Stress has a very considerable
influence on cognitive performance and definitely impacts on brain function --
so it was quite natural for us to ask whether the cognitive deficiencies
displayed by many breast cancer patients might not be attributable to the
stress that is inevitably associated with malignant disease."

Hermelink and her colleagues studied 166 women who had been diagnosed with
breast cancer and 60 others in whom screening of the breast had revealed no
signs of disease. The participants were assessed at three times during the
first year following the diagnosis. Prior to the first course of treatment, the
patients and the healthy controls exhibited very similar levels of performance
on standard cognitive tests. However, in one specific test of attention,
members of the patient group had a significantly higher error rate. "And
as we suspected at the outset, the higher failure rate in this test could be
linked to post-traumatic stress -- the greater the level of stress, the more
errors they made, and statistical analysis confirmed that the correlation was
highly significant," as Kerstin Hermelink explains.

Some good news too

Interestingly, the extent of pretreatment cognitive impairment detected in
the Cognicares study was considerably lower than that reported in several
earlier investigations. "This is probably because we took great pains to
control effectively for the possible impact of factors that could have
distorted the interpretation of the results," says Hermelink. "In
particular, we made sure that differences in the composition of the two groups
were minimized as far as possible." This is important because even slight
differences in age structure, level of education or intelligence between the
patients and the control group can result in discrepancies in cognitive
performance on standardized tests, which could mask -- or amplify -- the extent
of cognitive impairment displayed by the patients.

"For breast cancer patients our findings are good news," says
Kerstin Hermelink. "At all events -- in pretreatment phase at least --
they give no grounds for the belief that such patients suffer from more than
minimal cognitive deficiencies, which are induced by the stress associated with
the disease itself."

The Cognicares study is one of the most extensive investigations of its
kind yet carried out anywhere in the world. Six breast cancer centers located
in and around Munich participated in the project, which was made possible by a
grant from the Deutsche Krebshilfe (the German Cancer Aid). The results of the
tests undertaken after the termination of primary treatment are now being
analyzed.







Story Source:

The above story is based on materials provided by Ludwig-Maximilians-Universitaet
Muenchen (LMU). Note: Materials may be edited for content and length.







Journal Reference:

1.    K. Hermelink, V. Voigt, J. Kaste, F.
Neufeld, R. Wuerstlein, M. Buhner, K. Munzel, D. Rjosk-Dendorfer, S. Grandl, M.
Braun, F. E. von Koch, K. Hartl, S. Hasmuller, I. Bauerfeind, G. Debus, P.
Herschbach, N. Harbeck. Elucidating Pretreatment Cognitive Impairment
in Breast Cancer Patients: The Impact of Cancer-related Post-traumatic Stress. JNCI
Journal of the National Cancer Institute, 2015; 107 (7): djv099 DOI: 10.1093/jnci/djv099

http://www.sciencedaily.com/releases/2015/04/150417085226.htm

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