结直肠癌患者的神经认知功能和生活质量。
Neurocognitive function and quality-of-life in patients with colorectal cancer.
机构信息
College of Nursing, 985330 Nebraska Medical Center, University of Nebraska Medical Center (UNMC), Omaha, NE, 68198-5330, USA.
College of Medicine and Fred and Pamela Buffett Cancer Center, UNMC, Omaha, NE, USA.
出版信息
Eur J Oncol Nurs. 2023 Jun;64:102304. doi: 10.1016/j.ejon.2023.102304. Epub 2023 Mar 24.
OBJECTIVE
Colorectal cancer (CRC) survivors report significant long-term physical and cognitive declines post-treatment. Our purpose was to combine task-evoked Event-Related Potential (ERP) and resting state functional magnetic resonance imaging (rsf/MRI) methodologies to characterize the physiological underpinnings and cognitive sequelae of chemotherapy-related cognitive impairment, including changes in Quality-Of-Life (QOL) in patients with CRC, as compared to healthy control (HC) participants.
METHODS
This descriptive study recruited and obtained baseline data from patients with CRC at medical and surgical oncology visits four to six weeks post-op and followed them at 12- and 24-weeks. Procedures employed ERP, pencil and paper neuropsychological testing (N-P), structural/functional rsf/MRI, and self-report QOL methodologies. Data analyses included correlations, one-way ANOVA, Chi-square tests, and linear mixed models.
RESULTS
Study participants (n = 40) across groups (n = 15, 11, 14) were balanced on age, sex, education, and race, but not Several significant associations were found between changes in Dorsal Attention Network (DAN)-related ERP measures (P2, N2, N2P2, N2pc amplitudes), with QOL measures between baseline and last visits (p < 0.05-0.001). Additionally, rsf/MRI findings showed increased network activity in a single node of the DAN post-treatment, which was associated with poorer performance on N-P tests of attention and working memory, as well as a focal decline in grey matter volume in the area.
CONCLUSIONS
Our methodology revealed structural and functional changes within the DAN associated with altered spatial attention, working memory, and ability to inhibit. These disruptions may be responsible for decreased QOL ratings in patients with CRC. This study provides a putative mechanism of understanding how altered brain structural/functional relationships impact cognition, QOL, and nursing care in patients with CRC.
NCI TRIAL ID
NCI-2020-05952, University of Nebraska Medical Center, Clinical Trials.gov ID NCT03683004.
目的
结直肠癌（CRC）患者在治疗后会出现显著的长期身体和认知能力下降。我们的目的是结合任务诱发事件相关电位（ERP）和静息状态功能磁共振成像（rsf/MRI）方法，以描述化疗相关认知障碍的生理基础和认知后果，包括结直肠癌患者的生活质量（QOL）变化，并与健康对照组（HC）参与者进行比较。
方法
这项描述性研究招募了结直肠癌患者，并在手术后四到六周的医学和外科肿瘤就诊时获得了他们的基线数据，并在 12 周和 24 周时对他们进行了随访。研究采用了 ERP、纸笔神经心理学测试（N-P）、结构/功能 rsf/MRI 和自我报告 QOL 方法。数据分析包括相关性、单因素方差分析、卡方检验和线性混合模型。
结果
研究参与者（n=40）在组间（n=15、11、14）在年龄、性别、教育程度和种族上平衡，但不一致。几项重要的相关性研究发现，背侧注意网络（DAN）相关 ERP 指标（P2、N2、N2P2、N2pc 幅度）的变化与基线和最后一次就诊时的 QOL 指标之间存在显著相关性（p<0.05-0.001）。此外，rsf/MRI 研究结果显示，治疗后 DAN 的单个节点的网络活动增加，这与注意力和工作记忆的 N-P 测试表现较差以及该区域的灰质体积减少有关。
结论
我们的方法揭示了与空间注意力、工作记忆和抑制能力改变相关的 DAN 结构和功能变化。这些破坏可能是结直肠癌患者 QOL 评分下降的原因。本研究提供了一种潜在的机制，用于了解大脑结构/功能关系的改变如何影响结直肠癌患者的认知、QOL 和护理。
NCI 试验 ID：NCI-2020-05952，内布拉斯加大学医学中心，临床试验.gov ID NCT03683004。
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