Associations between inflammatory markers and cognitive function in breast cancer patients receiving chemotherapy.

BACKGROUND: Cancer-related cognitive impairment (CRCI) is often related to chemotherapy. Increased chronic inflammation is believed to play a key role in the development of CRCI related to chemotherapy but studies assessing this hypothesis specifically in patients receiving chemotherapy are rare. METHODS: We assessed several cognitive domains using the Cambridge Neuropsychological Test Automated Battery (CANTAB) in twenty-two breast cancer patients currently receiving chemotherapy. We also measured inflammatory cytokine and receptor (MCP-1, TNF-α, sTNFRI, sTNFRII) concentrations in patient sera using Luminex assays. These concentrations were log-transformed to obtain a normal distribution. Associations between log-transformed cytokines and cognition were evaluated using Pearson correlations and linear regression, taking into account relevant covariates. RESULTS: Increased concentrations of sTNFRI and sTNFRII were associated with poorer performance on the CANTAB Delayed Matching to Sample (DMS, tests visual memory). Increasing sTNFRI levels were negatively correlated with DMS percent correct (r=-0.47, p=0.029) and DMS percent correct after a 12 second (s) delay (r=-0.65, p=0.001). Increasing levels of sTNFRII negatively correlated with DMS percent correct after 12s delay (r=-0.57, p=0.006). After controlling for relevant demographic (i.e. age, education) and clinical variables (i.e. disease stage, regimen type), we found that increased sTNFRI remained significantly related to decline on the DMS at the 12s delay (p=0.018). CONCLUSION: This preliminary study shows a significant association between higher sTNFRI and lower scores on the short-term visual memory delayed match to sample test in breast cancer patients receiving chemotherapy, supporting the hypothesis that sTNFRI is involved in CRCI.

The EVMS pain education initiative: a multifaceted approach to resident education.

UNLABELLED: Chronic pain is a major health issue that causes significant patient morbidity as well as economic loss. Many studies have highlighted the lack of training in chronic pain management for resident physicians and the need to develop programs that address the challenges of providing care to chronic pain patients. We wanted to determine whether a workshop using a combination of standardized patients, small groups, and large group lectures addresses residents' curricular needs regarding chronic pain management. We developed a 1-day workshop for residents at Eastern Virginia Medical School, which has a nationally recognized professional skills center. After completing the workshop, residents showed significant gains in knowledge (post-test vs pre-test overall mean +23.4%, P < .001). Significant gains in clinical skills were also seen (overall +5.9%, P < .001) with improvements in the areas of pain assessment (+6.3%, P < .001), physical examination (+7.7%, P < .03), and pain management (+8%, P < .01). Physicians also reported increased comfort regarding chronic pain management. Almost all residents stated they would make specific practice changes in the assessment and management of chronic pain patients. The results suggest our workshop is a novel model that is effective in teaching residents how to assess and manage chronic pain. PERSPECTIVE: This article demonstrates that the use of standardized patients with other teaching methods is an effective approach in teaching resident physicians regarding the assessment and management of chronic pain patients. The findings have the potential to restructure our methods of teaching in chronic pain education.