Factores de riesgo de deterioro cognitivo asociado a cáncer en pacientes con carcinoma de mama y colon que reciben tratamiento con quimioterapia
DOI:
https://doi.org/10.23938/ASSN.1040Palabras clave:
Disfunción cognitiva, Neoplasia, Factor de riesgo, Quimioterapia, Polimorfismo genéticoResumen
Fundamento. Nuestro estudio se plantea con el objetivo de evaluar el impacto de diferentes factores individuales sobre el deterioro cognitivo relacionado con el cáncer en pacientes tratados con quimioterapia.
Material y métodos. Estudio unicéntrico longitudinal prospectivo. Incluyó pacientes con carcinoma de mama y colon tratados con quimioterapia. Se recogieron variables clínicas y genéticas del paciente (polimorfismos de nucleótido simple, SNP). Los pacientes fueron evaluados neurocognitivamente con once test validados, en tres momentos: basal previo a quimioterapia (M0), entre una y cuatro semanas tras finalizar quimioterapia (M1) y entre 24-30 semanas tras finalizar quimioterapia (M2).
Resultados. Se incluyeron 62 pacientes, 82% mujeres, con mediana de edad de 56 años (rango 30-74), un 64,5% con cáncer de mama. La edad <55 años, tener estudios superiores, ausencia de comorbilidades y presencia de la variante CC de rs471692 (TOP2A) se asociaron, en general, con mejores resultados cognitivos en M0. Se observó un empeoramiento significativo de M0 a M1 en los test RAVLT y Letras y números, y recuperación en M2 respecto a M0 en los test de memoria visual, FAST, clave de números, y cubos. La edad ≥55 años, la quimioterapia adyuvante, las comorbilidades, el consumo de tabaco y de alcohol y la variante GT de rs1800795 se relacionaron con el deterioro entre M0 y M1 en el modelo multivariante.
Conclusiones. La edad mayor de 55 años, el sexo femenino, la presencia de comorbilidades y el nivel básico de estudios se relacionan con un mayor riesgo de deterioro cognitivo tras el tratamiento con quimioterapia.
Descargas
Citas
OLIVEIRA AF, FERNANDES S, REIS JD, TORRES A, SANTOS IM, VON AH D. Cognitive functioning and work-related outcomes of non-central nervous system cancer survivors: protocol for a systematic review with meta-analysis. BMJ Open 2022; 12(7): e060300. http://doi.org/10.1136/bmjopen-2021-060300
MAYO SJ, LUSTBERG M, M DHILLON H, NAKAMURA ZM, ALLEN DH, VON AH D et al. Cancer-related cognitive impairment in patients with non-central nervous system malignancies: an overview for oncology providers from the MASCC Neurological Complications Study Group. Support Care Cancer 2021; 29(6): 2821-2840. http://doi.org/10.1007/s00520-020-05860-9
VAN DYK K, GANZ PA. Cancer-related cognitive impairment in patients with a history of breast cancer. JAMA 2021; 326(17): 1736-1737. http://doi.org/10.1001/jama.2021.13309
HARDY SJ, KRULL KR, WEFEL JS, JANELSINS M. Cognitive changes in cancer survivors. Am Soc Clin Oncol Educ Book 2018; 38(38): 795-806. http://doi.org/10.1200/EDBK_201179
WEFEL JS, VARDY J, AHLES T, SCHAGEN SB. International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 2011; 12(7): 703-708. http://doi.org/10.1016/S1470-2045(10)70294-1
WEFEL JS, LENZI R, THERIAULT RL, DAVIS RN, MEYERS CA. The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: results of a prospective, randomized, longitudinal trial: Results of a prospective, randomized, longitudinal trial. Cancer 2004; 100(11): 2292-2299. https://doi.org/10.1002/cncr.20272
AHLES TA, ROOT JC, RYAN EL. Cancer- and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol 2012; 30(30): 3675-3686. http://doi.org/10.1200/JCO.2012.43.0116
BAI L, YU E. A narrative review of risk factors and interventions for cancer-related cognitive impairment. Ann Transl Med 2021; 9(1): 72. http://doi.org/10.21037/atm-20-6443
AHLES TA, ANDREOTTI C, CORREA DD. Neuropsychological impact of cancer and cancer treatments. En: Holland JC et al. 3rd ed. Psycho-Oncology. Oxford University Press, 2015; 225-230. https://doi.org/10.1093/med/9780199363315.003.0029
AHLES TA, SAYKIN A. Cognitive effects of standard-dose chemotherapy in patients with cancer. Cancer Invest 2001; 19(8): 812-820. https://doi.org/10.1081/CNV-100107743
HAJJ A, KHOURY R, HACHEM R, AWAD A, HALLIT S, SACRE H et al. Clinical and genetic factors associated with self-reported cognitive deficits in women with breast cancer: the “CAGE-Cog” study. BMC Cancer 2022; 22(1): 996. http://doi.org/10.1186/s12885-022-10077-6
SAVAGE RM, GOUVIER WD. Rey Auditory-Verbal Learning Test: the effects of age and gender, and norms for delayed recall and story recognition trials. Arch Clin Neuropsychol 1992; 7(5): 407-414. http://doi.org/10.1016/0887-6177(92)90153-e
RYAN JJ, LOPEZ SJ. Wechsler adult intelligence scale-III. En: Understanding Psychological Assessment. Boston, MA: Springer US; 2001; 19-42.
CHLEBOWSKI C. Wechsler memory scale all versions. En: Encyclopedia of Clinical Neuropsychology. New York, NY: Springer New York; 2011. p. 2688-2690.
PEÑA-CASANOVA J. Programa integrado de exploración neuropsicológica - test barcelona: bases teóricas, objetivos y contenidos. Rev Logop Foniatr Audiol 1991; 11(2): 66-79. http://doi.org/10.1016/s0214-4603(91)75505-8
STROOP JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935; 18(6): 643-662. http://doi.org/10.1037/h0054651
TOMBAUGH TN. Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 2004; 19(2): 203-214. http://doi.org/10.1016/S0887-6177(03)00039-8
MCALLISTER TW, TYLER AL, FLASHMAN LA, RHODES CH, MCDONALD BC, SAYKIN AJ et al. Polymorphisms in the brain-derived neurotrophic factor gene influence memory and processing speed one month after brain injury. J Neurotrauma 2012; 29(6): 1111-1118. http://doi.org/10.1089/neu.2011.1930
BOWER JE, GANZ PA, IRWIN MR, CASTELLON S, AREVALO J, COLE SW. Cytokine genetic variations and fatigue among patients with breast cancer. J Clin Oncol 2013; 31(13): 1656-1661. http://doi.org/10.1200/JCO.2012.46.2143
MERRIMAN JD, AOUIZERAT BE, LANGFORD DJ, COOPER BA, BAGGOTT CR, CATALDO JK et al. Preliminary evidence of an association between an interleukin 6 promoter polymorphism and self-reported attentional function in oncology patients and their family caregivers. Biol Res Nurs 2014; 16(2): 152-159. http://doi.org/10.1177/1099800413479441
TAN CJ, LIM SWT, TOH YL, NG T, YEO A, SHWE M et al. Replication and meta-analysis of the association between BDNF Val66Met polymorphism and cognitive impairment in patients receiving chemotherapy. Mol Neurobiol 2019; 56(7): 4741-4750. http://doi.org/10.1007/s12035-018-1410-4
AHLES TA, SAYKIN AJ. Candidate mechanisms for chemotherapy-induced cognitive changes. Nat Rev Cancer 2007; 7(3): 192-201. http://doi.org/10.1038/nrc2073
MAGNUSON A, AHLES T, CHEN BT, MANDELBLATT J, JANELSINS MC. Cognitive function in older adults with cancer: Assessment, management, and research opportunities. J Clin Oncol 2021; 39(19): 2138-2149. http://doi.org/10.1200/JCO.21.00239
LANGE M, JOLY F, VARDY J, AHLES T, DUBOIS M, TRON L et al. Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors. Ann Oncol 2019; 30(12): 1925-1940. http://doi.org/10.1093/annonc/mdz410
TANNOCK IF, AHLES TA, GANZ PA, VAN DAM FS. Cognitive impairment associated with chemotherapy for cancer: report of a workshop. J Clin Oncol 2004; 22(11): 2233-2239. http://doi.org/10.1200/JCO.2004.08.094
LYCKE M, POTTEL L, POTTEL H, KETELAARS L, STELLAMANS K, VAN EYGEN K. Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment: Baseline cancer-related cognitive impairment. Psycho-Oncology. 2017; 26(5): 632-639. https://doi.org/10.1002/pon.4200
AHLES TA, SAYKIN AJ, MCDONALD BC, LI Y, FURSTENBERG CT, HANSCOM BS et al. Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Oncol 2010; 28(29): 4434-4440. http://doi.org/10.1200/JCO.2009.27.0827
MANDELBLATT JS, STERN RA, LUTA G, MCGUCKIN M, CLAPP JD, HURRIA A et al. Cognitive impairment in older patients with breast cancer before systemic therapy: is there an interaction between cancer and comorbidity? J Clin Oncol 2014; 32(18): 1909-1918. http://doi.org/10.1200/JCO.2013.54.2050
ANSTEY KJ, VON SANDEN C, SALIM A, O’KEARNEY R. Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol 2007; 166(4): 367-378. http://doi.org/10.1093/aje/kwm116
SABIA S, ELBAZ A, BRITTON A, BELL S, DUGRAVOT A, SHIPLEY M et al. Alcohol consumption and cognitive decline in early old age. Neurology 2014; 82(4): 332-339. http://doi.org/10.1212/WNL.0000000000000063
AHLES TA, SAYKIN AJ, NOLL WW, FURSTENBERG CT, GUERIN S, COLE B et al. The relationship of APOE genotype to neuropsychological performance in long-term cancer survivors treated with standard dose chemotherapy. Psychooncology 2003; 12(6): 612-619. http://doi.org/10.1002/pon.742
NG T, TEO SM, YEO HL, SHWE M, GAN YX, CHEUNG YT et al. Brain-derived neurotrophic factor genetic polymorphism (rs6265) is protective against chemotherapy-associated cognitive impairment in patients with early-stage breast cancer. Neuro Oncol 2016; 18(2): 244-251. http://doi.org/10.1093/neuonc/nov162
MERRIMAN JD, AOUIZERAT BE, CATALDO JK, DUNN L, COOPER BA, WEST C et al. Association between an interleukin 1 receptor, type I promoter polymorphism and self-reported attentional function in women with breast cancer. Cytokine 2014; 65(2): 192-201. http://doi.org/10.1016/j.cyto.2013.11.003
CHAE J-W, NG T, YEO HL, SHWE M, GAN YX, HO HK et al. Impact of TNF-α (rs1800629) and IL-6 (rs1800795) polymorphisms on cognitive impairment in Asian breast cancer patients. PLoS One 2016; 11(10): e0164204. http://doi.org/10.1371/journal.pone.0164204
Publicado
Cómo citar
Número
Sección
Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución-CompartirIgual 4.0.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
