Journal Article Annotations
2022, 3rd Quarter
Annotations by Marie Tobin MD, Carlos Fernandez-Robles MD
This scoping review explored cancer related fatigue (CRF) in survivors of childhood cancer, defined as those who were under 21 years of age at diagnosis. Forty-nine articles with 20,145 participants were included. The authors identified 59 contributors to CRF, most prominently sex, diagnosis, and physical activity level. Ten of the 49 included studies reported on the efficacy of non-pharmacological interventions for alleviating CRF: 2 studies found that exercise counselling improved CRF; 1 study showed that cognitive behavioural therapy (CBT) targeting factors that might maintain CRF was effective; and 2 studies of yoga interventions showed efficacy but did not include control groups. To date, non-pharmacological interventions aimed at addressing physical activity level, psychosocial factors (i.e., coping difficulties, fear of cancer recurrence, dysfunctional cognition, dysfunctional social interactions, sleep-wake cycle, activity regulation) somatization, and self-efficacy toward exercise can positively impact contributors to CRF.
Strength and weaknesses:
Strengths of this review include that it addresses a common but understudied problem. The authors state clear objectives and apply clear definitions for CRF, contributors (candidate and significant) to CRF, and non-pharmacological interventions. All cancer types are included. The authors adequately justify the rationale for using a scoping rather than a systematic review. However, there is no discussion of the quality of included studies. Consequently, there is a risk of study quality varying greatly among the reported findings and related recommendations.
Adult survivors of childhood cancer are a growing population. CRF is common in this group (with prevalence estimates varying from 0% to 62%) and a source of much distress. This study considers numerous plausible factors that may contribute to CRF in adult survivors of childhood cancer and further highlights which factors may contribute most significantly while also being amenable to intervention. This broad bottom-up approach stands to guide future research to identify actual risk factors and effective non-pharmacological interventions.
Brain-Derived Neurotrophic Factor (BDNF) is a potential biomarker for monitoring health in cancer patients, but the existing evidence regarding BDNF single nucleotide polymorphisms and cancer-related cognitive impairment (CRCI) is inconclusive. In a systematic review of 26 articles, the existing research on interventions to improve cognitive performance in cancer patients does not provide definitive information regarding the correlation of BDNF with symptom improvement.
Strength and weaknesses:
This is a well-designed systematic review with a thorough search methodology, independent evaluation of articles, consideration of included studies’ reproducibility, and detailed description of search parameters. The weaknesses of this review relate to the quality of available papers, which were often limited by small sample sizes or methodological considerations.
Cancer-related cognitive impairment (CRCI) impacts many patients undergoing cancer treatment, its diagnosis is challenging, and its symptoms can cause significant disability over several years before resolving fully. Multiple hypotheses regarding the cause of CRCI exist, most of which are linked to inflammatory response and oxidative stress during cancer and its treatment. The role of BDNF is a relatively new topic, and a wide range of methodologically varied studies have emerged in the past 5 years. This systematic review does an excellent job at comprehensively evaluating the association between BDNF biomarkers and neurocognitive impairment among cancer patients and presenting it critically. The authors provide thoughtful recommendations for future research on this topic. Given the importance of this topic to the practice of psycho-oncology, this manuscript is essential to C-L psychiatrists caring for patients who are undergoing cancer care or subsequently.
This survey of 90 centers conducting pre-hematopoietic stem cell transplants (pre-HSCT) found that all conduct pre-HSCT psychosocial assessments. These assessments include psychiatric and substance use history, social history, and availability of support structures. Eighty-eight percent evaluate all patients, and the remaining do so in specific situations (i.e., allogenic transplant, insurance requirement, high-risk cases). Beyond this point, there is great variability regarding assessing other clinical and legal factors and using standardized measures. Finally, psychosocial factors could influence transplant eligibility in two-thirds of the centers.
Strength and weaknesses:
This study surveyed a large number of Transplant Centers and obtained a 64% response rate with a balanced geographical and size respondent distribution. By inquiring about psychosocial assessments, the investigators obtained valuable information missed by previous studies that only focused on psychiatric evaluations. Furthermore, characterizing the psychosocial assessment allows for rich insights into current practices. The study’s weaknesses include a lower response rates for certain questions and the inability to capture the internal variability of reported clinical practices.
The psychosocial care of cancer patients has been an increasing focus over the past two decades; however, progress has been heterogenous, and best practices are not clearly defined. This manuscript’s findings illustrate the variability in practices among transplant centers for patients before pre-HSCT. The study also highlights the need for consensus and evidence-based guidelines beyond the mere requirement of evaluations. C-L psychiatrists are positioned to lead efforts to create or improve psychosocial assessment policies for this medically and psychiatrically vulnerable patient population.