背景:化疗诱导的周围神经病变(CIPN)在癌症幸存者中很常见且致残。关于CIPN与其他神经系统完整性指标的关联知之甚少,如执行功能障碍。我们比较了有和没有CIPN的老年化疗癌症幸存者的执行功能指标。
方法:这项横断面研究纳入了50名接受化疗的癌症幸存者(65.6±11.5年,88%的女性)化疗后治疗,先前应癌症幸存者或医疗提供者的要求转诊为门诊康复。22名参与者(44%)有患者报告的远端感觉异常或麻木定义的CIPN,从化疗开始,一直持续到认知测试。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检验在有和没有CIPN的癌症幸存者之间进行评估。然后使用多变量模型来确定CIPN是否是执行功能测量的独立决定因素(Trails-B,Stroop不一致,和RRA)。模型根据年龄进行了调整,性别,焦虑史,和苯二氮卓类药物的使用,因为它们与CIPN和执行功能的已知关联。
结果:患有CIPN(CIPN)的癌症幸存者与没有CIPN(CIPN-)的幸存者相比,在Trails-B(CIPN:84.9s±44.1s,CIPN-:59.1s±22.5s,p=0.01),Stroop(CIPN+:100.6s±38.2s,CIPN-:82.1s±17.3s,p=0.03),和RRA(CIPN+:60.3%±12.9%,CIPN-:70.6%±15.7%,p=0.01)。根据患者报告或坐姿功能,癌症分期严重程度或功能状态没有差异。校正年龄后,在多变量模型中发现CIPN与执行功能降低之间的关联,性别,焦虑,和苯二氮卓用于Trails-B(β:17.9,p=0.046),Stroop(β:16.9,p=0.02),和RRA(β:-0.072,p=0.03)。
结论:在这个人群中,在接受化疗的老年癌症幸存者中,CIPN与执行功能降低相关。未来的研究需要进一步了解这种初步的关联,因果关系,以及潜在的风险因素。
BACKGROUND: 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.
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).
CONCLUSIONS: 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.