A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients / 간호학회지

PURPOSE: This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model. METHODS: The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. RESULTS: The modified model was a good fit for the data. The model fit indices were χ2=423.18 (p<.001), χ2/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=−.51, p=.001), symptom experiences (β=−.27, p=.001), menopausal symptoms (β=−.22, p=.008), and chemotherapy-related cognitive impairment (β=−.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%. CONCLUSION: These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

Relationship between Blood Mercury and Cardiovascular Risk, Neuropathic Symptoms of Adults in a Yeong-dong Area of Gangwon-do

BACKGROUND: Exposure to mercury is known to affect the nervous system and cardiovascular system, but effects of chronic exposure to mercury remain unclear. This study aimed to investigate the effects of high blood mercury concentrations on the health of patients living in the Yeong-dong region.METHODS: We analyzed the relationship between blood mercury concentration and cardiovascular risk and neuropathic symptoms for 555 patients whose blood mercury concentration was tested from 1999 to 2017. We analyzed the association of each lipid component and blood mercury concentration through a partial correlation method. We performed an analysis to determine the odds ratios (ORs) of hypertension, diabetes mellitus, and obesity to high blood mercury levels through a logistic regression model. We analyzed the association between mercury levels and neuropathic symptoms using a χ² test and calculated the OR.RESULTS: The average blood mercury concentration was 8.1±7.5 µg/L and 5.5±5.2 µg/L for males and females, respectively. There was a positive correlation of mercury concentration with high density lipoprotein cholesterol (r, 0.268, 0.219; P-value, <0.001). Among other cardiovascular disease risk factors, no significant correlation was found with high blood mercury level. A tingling sensation in females was related to a high blood mercury level (OR, 2.080; 95% confidence interval, 1.119–3.866).CONCLUSION: It was found that higher mercury concentrations could affect high-density lipoprotein cholesterol regardless of sex and can cause a tingling sensation in women.

A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients

PURPOSE@#This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model.@*METHODS@#The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs.@*RESULTS@#The modified model was a good fit for the data. The model fit indices were χ2=423.18 (p<.001), χ2/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=−.51, p=.001), symptom experiences (β=−.27, p=.001), menopausal symptoms (β=−.22, p=.008), and chemotherapy-related cognitive impairment (β=−.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%.@*CONCLUSION@#These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

Changes of Cognitive Function and Depression following Chemotherapy in Women with Breast Cancer: A Prospective Study

PURPOSE: This study was done to identify the changes of cognitive function and depression following Chemotherapy in women with breast cancer. METHODS: Fifty patients participated in the study and completed the questionnaire at three-time points: pre-chemotherapy, post-chemotherapy, and six months after the completion of chemotherapy. The assessment tools were: everyday cognition, the Montreal Cognitive Assessment, and the Hospital Anxiety and Depression Scale. Data were analyzed using descriptive statistics and repeated measures analysis of variance. RESULTS: Immediately after chemotherapy, 52.0% of patients complained of subjective cognitive decline and reported greater difficulty in the cognitive domains of attention, memory, and visuospatial abilities. At six-month follow-up, 24.0% of patients exhibited mild cognitive decline. Repeated measures ANOVA showed a significant decline in cognitive function after chemotherapy. However, improvement was observed 6 months after the completion of chemotherapy. Depression showed similar patterns to cognitive function. Higher cognitive decline scores were significantly correlated with higher depression (r=.33, p=.020). CONCLUSION: These results suggest that chemotherapy is highly associated with cognitive decline and depression in women with breast cancer. Nursing intervention is needed to relieve depression as well as cognitive decline in patients undergoing chemotherapy.

Effect of Cancer Symptoms and Fatigue on Chemotherapy-related Cognitive Impairment and Depression in People with Gastrointestinal Cancer

PURPOSE: The purpose of this study was to test a hypothetical model of chemotherapy-related cognitive impairment (CRCI) and depression in people with gastrointestinal cancer. METHODS: A purposive sample of 198 patients undergoing chemotherapy was recruited from November 2014 to July 2015. The instruments were Everyday Cognition (ECog), Hospital Anxiety Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module. Data were analyzed using descriptive statistics, correlation, and path analysis. RESULTS: CRCI was directly affected by cancer symptoms (β=.19, p=.004) and fatigue (β=.56, p<.001)(R²=47.2%). Depression was directly affected by fatigue (β=.48, p<.001) and CRCI (β=.27, p<.001). However, The impact of cancer symptoms on depression was confirmed through the mediating effect of CRCI. CONCLUSION: Results indicate that in patients with gastrointestinal cancer undergoing chemotherapy along with the direct physiologic effects (fatigue, symptoms) of cancer treatment may have altered cognitive function leading to depression.