Association of Fatigue Intensification with Cognitive Impairment during Radiation Therapy for Prostate Cancer

Feng, Linyin; Espina, Alexandra; Saligan, Leorey N.

doi:10.1159/000487081

Cited by 19 publications

(17 citation statements)

References 53 publications

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“…Cognitive deficits are commonly observed in patients with cancer, particularly in complex information processing speed, working memory, learning efficiency, and executive functions . This illustrates the involvement of the fronto‐subcortical system which is consistent with the observation that lower cognitive performance and fatigue in cancer patients was accompanied by hyperactivation in the prefrontal cortex with increasing task difficulty .…”

Section: Introductionsupporting

confidence: 86%

“…Even though cognitive and motor fatigue may be distinguishable by symptom presentation, it is possible that they originate from the same upstream pathogenic mechanisms. Both cognitive and motor fatigue can be affected by inflammation associated with cancer or cancer treatment . Oxidative damage induced by RT can target sarcoplasmic reticulum calcium release channels affecting force generation capacity, as well as caspase/calpain pathways leading to contractile protein catabolism and muscle weakness .…”

Section: Discussionmentioning

confidence: 99%

“…The Stroop Color‐Word test is a well‐established tool designed to measure aspects of executive function, which is a cognitive domain associated with CRF in previous studies . Patients completed a computerized version of the Stroop Color‐Word Interference Test, in which colored computer keys were used to name colors.…”

Section: Methodsmentioning

confidence: 99%

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Cognitive and motor aspects of cancer‐related fatigue

et al. 2019

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Background Cancer‐related fatigue (CRF) is a debilitating symptom frequently reported by patients during and after treatment for cancer. CRF is a multidimensional experience and is often solely assessed by self‐report measures. The goal of the study is to examine the physical and cognitive aspects of self‐reported CRF using a cognitive function test and a physical fatigue index in order to provide objective measures that can characterize the CRF phenotype. Methods A total of 59 subjects with nonmetastatic prostate cancer receiving external beam radiation therapy were included in the study. Fatigue was measured using the Functional Assessment of Cancer Therapy‐Fatigue (FACT‐F) questionnaire. Cognitive characteristics of CRF was measured using the Stroop Color‐Word Interference computerized test and the motor aspect of fatigue was measured using the static fatigue test using a handgrip dynamometer. Findings Functional Assessment of Cancer Therapy‐Fatigue scores significantly correlated with the Stroop Interference score, but not performance accuracy in all test conditions. Fatigued subjects exhibited a more rapid decline to 50% of maximal strength and increased static fatigue index in the handgrip test, whereas maximal grip strength was not affected. Conclusions The results suggest that CRF exhibits both cognitive and physical characteristics. Subjective fatigue was associated with increased time required to overcome cognitive interference, but not cognitive performance accuracy. Fatigued patients exhibited decreased physical endurance and the ability to sustain maximal strength over time. These objective measures may serve as valuable tools for clinicians to detect cognitive and physical impairment associated with CRF.

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Section: Introductionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Cognitive and motor aspects of cancer‐related fatigue

et al. 2019

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“…Fatigue is a common symptom associated with cancer and cancer treatments, including chemotherapy and radiation therapy, and it can dramatically impact quality of life [1]. Cancerrelated fatigue (CRF) often co-occurs with other symptoms, including cognitive deficits, even when the central nervous system is not directly affected by the cancer or the treatment [2,3]. It is therefore likely that systemic changes, for example changes in immune response [4], are causing the co-occurrence of symptoms, but the process remains poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Induction of fatigue-like behavior by pelvic irradiation of male mice alters cognitive behaviors and BDNF expression

et al. 2020

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Fatigue and cognitive deficits are often co-occurring symptoms reported by patients after radiation therapy for prostate cancer. In this study, we induced fatigue-like behavior in mice using targeted pelvic irradiation to mimic the clinical treatment regimen and assess cognitive behavioral changes. We observed that pelvic irradiation produced a robust fatigue phenotype, a reduced rate of spontaneous alternation in a Y-maze test, and no behavioral change in an open field test. We found that reversal learning for fatigued mice was slower with respect to time, but not with respect to effort put into the test, suggesting that fatigue may impact the ability or motivation to work at a cognitive task without impairing cognitive capabilities. In addition, we found that mice undergoing pelvic irradiation show lower whole-brain levels of mature BDNF, and that whole-brain proBDNF levels also correlate with spontaneous alternation in a Y-maze test. These results suggest that changes in BDNF levels could be both a cause and an effect of fatigue-related changes in behavior.

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“…In addition to inflammation, there is evidence that clinical variables can influence the persistent fatigue experience after RT. In up to 60% of cancer-free survivors who received RT, persistent fatigue was associated with functional disability, pain, sleep disturbance, distress, depression, and cognitive impairment [2, 12-15]. In a previous study of men with fatigue 1 year after RT completion for prostate cancer, fatigue was not associated with age, body mass index (BMI), ADT use, hemoglobin level, or gastrointestinal integrity [8].…”

Section: Introductionmentioning

confidence: 99%

Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer

et al. 2019

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Purpose: Cancer-related fatigue is one of the most debilitating side effects of cancer and cancer therapy. We aimed to investigate co-occurring symptoms associated with persistent fatigue in men receiving external beam radiation therapy (EBRT) for nonmetastatic prostate cancer. Methods: A sample of 47 men with prostate cancer scheduled to receive radiotherapy (RT) were followed at baseline and 1 year after RT. Clinical and demographic data were obtained from chart review. Symptom measurements included urinary dysfunction (American Urological Association symptoms score), fatigue (Functional Assessment of Cancer Therapy – Fatigue questionnaire), sleep disturbance (Patient-Reported Outcomes Measurement Information System – Sleep Disturbance form), pain (physical well-being domain pain item of the Functional Assessment of Cancer Therapy – General), and depressive symptoms (Hamilton Depression Rating Scale). Paired t tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue and other symptom scores. Results: At 1 year after RT, 34% of subjects continued to experience fatigue. Urinary dysfunction was the best clinical predictor of persistent fatigue. Pain and depressive symptoms further improved the predictive power of the model. A multivariate linear regression model containing all these three clinical variables (urinary dysfunction, pain, and depressive symptoms) explained 74% of total variance associated with persistent fatigue after RT. Conclusions: Persistent fatigue at 1 year after EBRT in prostate cancer survivors is likely related to a cluster of symptoms elicited by chronic inflammation. Therapies that target each of these symptoms will likely reduce fatigue in this patient population.

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Association of Fatigue Intensification with Cognitive Impairment during Radiation Therapy for Prostate Cancer

Cited by 19 publications

References 53 publications

Cognitive and motor aspects of cancer‐related fatigue

Cognitive and motor aspects of cancer‐related fatigue

Induction of fatigue-like behavior by pelvic irradiation of male mice alters cognitive behaviors and BDNF expression

Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer

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