Predictors of cognitive failures in cancer survivors.

BACKGROUND: Progress in cancer dia-gnostic and treatment increases the probability of survival and survival time in cancer patients. Current research focuses on the quality of life of cancer survivors and the late effects of treatment, which can take the form of cognitive failures in daily life. The aim of the presented research was to examine the relationships between subjectively-reported cognitive failures and selected socio-demographic, clinical, and psychological characteristics (age, hormonal treatment, depression, anxiety, fatigue, sleep satisfaction). PATIENTS AND METHODS: The research sample consisted of 102 cancer survivors aged 25-79 years and a mean time since the end of the last treatment was 17.4 months (standard deviation = 15.4). The largest part of the sample consisted of breast cancer survivors (62.4%). The level of cognitive errors and failures was measured by the Cognitive Failures Questionnaire. The PHQ-9 Patient Health Questionnaire, the GAD-7 General Anxiety Disorder Scale, and the WHOQOL-BREF Quality of Life Questionnaire were used to measure depression, anxiety, and selected aspects of quality of life. RESULTS: An increased level of cognitive failures in daily life was found in approximately one-third of cancer survivors. The overall cognitive failures score is strongly related to the level of depression and anxiety. Decreasing levels of energy and sleep satisfaction are associated with increasing cognitive failures in everyday life. The age and hormonal therapy do not significantly differentiate the level of cognitive failures. In the regression model, which explained 34.4% of the variance of subjectively-reported cognitive functioning, depression was the only significant predictor. CONCLUSION: The study results mention relationship between subjective evaluation of cognitive functioning and emotional experience in cancer survivors. The administration of self-reported methods for measuring cognitive failures can be helpful in clinical practice in identifying psychological distress.

Neurobio-logy of multiple myeloma and its therapeutical use - results of the pilot study with a control arm.

BACKGROUND: Myeloma cells, occupying a bone marrow niche, are influenced not only by neighbouring stroma cells but also by signals from the axons of sympathetic nervous system. The nervous system is directly involved in the process of myeloma progression. Among other cancers, patients with myeloma suffer the most difficult distress generating intensive adrenergic signals, causing its further progression. There is a question arising from these facts regarding whether psychological interventions, modulating a function of the nervous system, can further improve outcomes of myeloma treatments. We focus on interactions between myeloma cells and the nervous system. PATIENTS AND METHODS: Twelve patients with monoclonal gamapathy of indetermined significance (MGUS) or myeloma have participated in this study; eight in the interventional arm with the intervention of forgiveness therapy and four in the control arm. The patients were in various phases of their treatment, from active observation to immuno-chemotherapy and autologous stem cell transplant. Two major types of parameters were measured during the intervention: parameters of the activity of the disease (MGUS or myeloma) and psycho-neuro-immunological parameters of the patient, such as psychological depression, anxiety, and anger by the validated test PROMIS), as well as activity of the autonomic nervous system by heart rate variability, and immune profile by flow cytometry of peripheral blood. RESULTS: Patients who completed the forgiveness intervention showed improvement of depression, anxiety, and anger measured by PROMIS above population average, significant expansion of physiological plasma cells CD138+38+ (P = 0.04), B memory lymphocytes CD27+ (P = 0.02), and dendritic plasmacytoid cells CD123+ (P = 0.03). Parameters of heart rate variability such as parasympatic nervous system (PNS) index, sympatic nervous system (SNS) index, stress index, standard deviation of NN intervals (SDNN) and root mean square of the successive differences (RMSSD) had improved in a majority of patients. CONCLUSION: An intervention centered on forgiveness therapy was able to improve distress, reduce adrenergic signals in the autonomic nervous system, and restore parameters of the immune profile of patients with plasma cell dyscrasia who suffered from chronic stress caused by repressed anger and unforgiveness. Integrative treatment of myeloma can improve the quality of life of patients and thus affect the efficiency of immuno-chemotherapy. New randomised trials are warranted to test the integrative treatment of myeloma that might be able to improve overall survival.