Cancer-related cognitive impairment in older adults with acute myeloid leukemia treated with hypomethylating agents and venetoclax chemotherapy: a longitudinal descriptive study.

PURPOSE: To explore cancer-related cognitive impairment (CRCI) in older adults with acute myeloid leukemia (AML) receiving venetoclax in combination with hypomethylating agents or low-dose cytarabine chemotherapy. METHODS: This study is a longitudinal, qualitative descriptive study. Participants were recruited using purposive sampling. Semi-structured interviews were conducted among 11 older adults with AML at cycle 2, cycle 4, and cycle 7 of chemotherapy. An early end-of-study interview was conducted for those who changed treatment plans during the study follow-up. RESULTS: A total of 22 transcripts were included for thematic analysis. Four themes emerged: (1) CRCI experiences, (2) impact of CRCI, (3) CRCI coping strategies, and (4) perceived CRCI-related factors. Older adults with AML experienced challenges in memory, language, and attention both intermittently and daily. These cognitive changes impacted their emotion, daily activities, social connection, and their caregivers' responsibilities. Hence, these older adults with AML developed problem-solving and emotional coping strategies to cope with CRCI. Older adults with AML also identified demographic, physiology/clinical, psychological, and other factors that might contribute to CRCI. CONCLUSION: This study offers important insight for clinicians to understand how older adults with AML experience CRCI and how it impacts their daily routines. It indicates that clinicians should ask patients about their experience with cognitive changes at each encounter to provide support or coping strategies as needed to prevent CRCI from further hindering their quality of life.

"A strong reason why I enjoy coming to work": Clinician acceptability of a palliative and supportive care intervention (PACT) for older adults with acute myeloid leukemia and their care partners.

INTRODUCTION: Studies about clinician acceptability of integrative palliative care interventions in the inpatient and outpatient cancer settings are limited. In this study, we examined clinician acceptability of a NIH-funded interdisciplinary PAlliative and Supportive Care inTervention (PACT) for older adults with acute myeloid leukemia (AML) and their care partners that transcends both inpatient and outpatient settings. MATERIALS AND METHODS: Data was collected using semi-structured interviews with clinicians who were directly involved in PACT. The domains of the Theoretical Framework of Acceptability were used to guide the qualitative analysis. RESULTS: The clinicians consisted of occupational therapists (37%), physical therapists (25%), registered nurses (25%), and a clinical rehabilitation manager (13%). Five themes were identified in the thematic analysis: (1) Emotions and affect towards the intervention, (2) Intervention coherence and self-efficacy, (3) Barriers, burden, and opportunity costs of delivering the intervention, (4) Usefulness and effectiveness of the intervention, and (5) Recommendations to improve intervention delivery. DISCUSSION: All clinicians found the PACT intervention highly acceptable and expressed the positive impact of the intervention on job fulfillment and satisfaction. Our findings provide evidence to inform the delivery and implementation of future large scale integrative palliative care intervention trials.

Care partners experience of an oral health intervention for individuals with mild cognitive impairment and mild dementia using behavior change technique: A qualitative study.

Oral health declines in older adults with cognitive impairment. We aimed to improve oral hygiene outcomes for individuals with mild cognitive impairment (MCI) or mild dementia (MD) by fostering behavior changes among carepartners assisting them. We used qualitative data of verbatim transcripts of coaching sessions with carepartners (n = 17 dyads:10 dyads for MCI, 7 dyads for MD). Directed and emergent coding were used to understand behavior change techniques (BCTs). BCTs were compared with carepartners of participants with MCI and MD. Most frequently used BCTs in both groups: prompts and cues, instruction on how to perform the behavior, review behavioral goal, and problem solving. Different BCTs emerged in study: social support-unspecified of the MCI group and credible source for MD group. Findings clarified active intervention components, common BCTs used by carepartners, and different BCT approaches for both participants. Findings help to elucidate the mechanisms of changes in individuals' behaviors in these interventions.

Neuropathic Pain Affects Quality of Life in Breast Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy.

BACKGROUND: Despite the significant impact of chemotherapy-induced peripheral neuropathy on the quality of life for breast cancer survivors, there is a notable lack of comprehensive research. Therefore, a crucial need exists for further systematic investigation and inquiry into this matter. AIMS: This study examined predictors of quality of life in breast cancer survivors with chemotherapy-induced peripheral neuropathy. DESIGN: A cross-sectional, correlational design. SETTINGS: This study was conducted at a medical center in northern Taiwan and a teaching hospital in northeastern Taiwan. PARTICIPANTS/SUBJECTS: One hundred and thirty adult women with breast cancer, who have undergone chemotherapy and obtained a Total Neuropathy Scale-Clinical Version score>0, were enrolled. METHODS: Neuropathic pain, sleep disturbances, depression, and quality of life were evaluated using multiple regression analysis to identify quality of life predictors. Clinical importance was established using the minimally important difference of Functional Assessment of Cancer Therapy-Breast. RESULTS: The study indicated that improving depression (B = -10.87, p < .001) and neuropathic pain (B = -8.33, p = .004) may enhance the quality of life of breast cancer survivors with chemotherapy-induced peripheral neuropathy. Moreover, the individual's marital status and family history of breast cancer were identified as predictive factors. CONCLUSIONS: This study illuminates quality of life determinants for breast cancer survivors with chemotherapy-induced peripheral neuropathy, advocating comprehensive care and addressing depression and neuropathic pain for better outcomes.

Comparing the Experiences of Participants With Mild Cognitive Impairment and Mild Dementia During an Oral Health Intervention.

Background and Objectives: Cognitive impairment is associated with poor oral health outcomes. Oral hygiene tasks are an essential target of interventions aiming to improve oral health for older adults with cognitive impairment. We aimed to examine whether experiences in an oral health intervention based on the Adaptive Leadership Framework for Chronic Illness differed between individuals with mild cognitive impairment (MCI) or mild dementia (MD) and their respective care partners. Research Design and Methods: This was a secondary analysis using directed content analysis and then an interpretive-description approach to analyze the data from a theory-driven intervention study. We included 10 people with MCI and their care partners (n = 20) and 8 people with MD and their care partners (n = 16) in the treatment arm of the intervention. For each participant, we analyzed audio recordings of 4 intervention coaching sessions, each ranging between 30 and 45 min. We managed the data and coding using ATLAS.TI software. Results: Participants in both the MCI and MD groups experienced similar challenges in adapting to changes in oral hygiene techniques, and both groups worked on learning new oral hygiene techniques taught by the dental hygienist and meeting individualized goals developed with their care partner, interventionist, and hygienist. On the other hand, there were subtle differences in technical challenges between participants in MCI and MD groups; participants in the MCI group reacted more actively to dental hygienist suggestions than the MD group. Discussion and Implications: Study findings provide information about how researchers and clinicians might tailor interventions to meet the learning needs of individuals and care partners in each group.

Patient-reported motor chemotherapy-induced peripheral neuropathy impacts function in advanced colorectal cancer survivors receiving chemotherapy: A cross-sectional study.

AIMS: Chemotherapy-induced peripheral neuropathy limits cancer survivors' compliance with chemotherapy and impaired function. This study aimed to examine separate impacts of clinician-assessed, patient-reported sensory and motor chemotherapy-induced peripheral neuropathy on physical/role function and functional interference in advanced colorectal cancer survivors receiving chemotherapy. METHODS: A cross-sectional, correlational design utilizing convenience sampling enrolled 75 stage III or IV colorectal cancer adults undergoing chemotherapy. Participants filled out the Patient Neurotoxicity Questionnaire, Identification Pain Questionnaire, and Peripheral Neuropathy Scale. Then, a trained research nurse conducted a brief neurological assessment using the Total Neuropathy Scale - clinical version. RESULTS: The prevalence of sensory and motor chemotherapy-induced peripheral neuropathy was from 34.7% to 54.7% and from 16.0% to 17.3%, respectively. Further, 20% of participants suffered from neuropathic pain. A low correlation between clinician-assessed and patient-reported chemotherapy-induced peripheral neuropathy was detected. The function was significantly impacted by patient-reported motor chemotherapy-induced peripheral neuropathy. CONCLUSIONS: This study was superior in utilizing the brief and valid patient-reported and clinician-assessed tools to measure sensory and motor chemotherapy-induced peripheral neuropathy. Moreover, the identification of patient-reported motor symptoms has the largest influence on function in advanced colorectal cancer survivors. Nurses may use the brief and easily administered tools in clinical settings for effective screening and early detection of motor and sensory chemotherapy-induced peripheral neuropathy to prevent functional decline in advanced colorectal cancer survivors. However, this study was still limited because of the cross-sectional design, small sample size, sample heterogeneity, and recruiting participants from only one medical center.

Perspectives of caregivers of older adults with acute myeloid leukemia during initial hypomethylating agents and venetoclax chemotherapy.

BACKGROUND: Older adults with AML commonly receive a hypomethylating agent (HMA) as first-line therapy. The addition of venetoclax (VEN) to HMAs has been shown to improve remission rates and overall survival. The use of combination therapy (HMA + VEN) requires frequent follow-up, results in longer infusion times, and likely increases caregiver responsibility at home. We describe experiences of informal caregivers (family/friends) providing care to older adults with AML receiving HMA + VEN. METHODS: Fourteen caregivers of older adults with AML receiving HMA + VEN (September 2020 to September 2021) were recruited as part of a control group of an ongoing NIH-funded clinical trial. Semi-structured interviews were conducted to gain initial insight into caregiver experiences at the start of HMA + VEN treatment. Two researchers analyzed the data using thematic content analysis. Data saturation occurred when no new themes were found in subsequent interviews, but all interviews were coded and synthesized. RESULTS: Of the 14 caregivers interviewed, the majority were spouses (n = 10), female (n = 13), and aged 45 to 83 (median age 65). We identified five themes: (1) the impact of an AML diagnosis in older adulthood, (2) care recipient condition changes, (3) perspectives of caregiving roles and tasks, (4) factors influencing caregiving experiences, and (5) support system roles. CONCLUSIONS AND IMPLICATIONS: Caregivers for older adults with AML report a range of experiences navigating health systems, caregiving responsibilities, and resource needs. The risk for caregiver burden and unmet needs should be addressed to improve caregivers' abilities to provide care.

Cognitive Function in Adults With Acute Myeloid Leukemia Treated With Chemotherapy: A Systematic Review.

BACKGROUND: Chemotherapy is essential for treating acute myeloid leukemia (AML). Previous studies concluded that survivors of cancer who were treated with chemotherapy experience cognitive impairment. Therefore, it is important to understand cognitive function in survivors of AML. OBJECTIVE: The aim of this study was to explore distributions and correlates of cognitive function, and prediction of cognitive function on other outcomes in adults with AML who were treated with chemotherapy. METHODS: A health science librarian systematically searched PubMed, CINAHL, PsycINFO, and EMBASE databases. Two reviewers independently conducted the title, abstract, and full-text screening. Data were extracted and synthesized based on the aims of the review. RESULTS: A total of 10 articles were included. Findings indicate that up to 62.2% of adults with AML experienced impaired cognitive function after starting chemotherapy. Three studies found cognitive function remained stable over time. Education and cytokines were potential correlates of cognitive function. Worse cognitive function may predict lower physical performance and higher mortality, although the results were inconsistent across studies. CONCLUSION: Impaired cognitive function was observed in adults with AML who were treated with chemotherapy. However, no study used a validated subjective cognitive-function-specific patient-reported questionnaire, and previous studies focusing on cognitive function included relatively young samples. Hence, further research on cognitive function in older adults with AML is needed. IMPLICATIONS FOR PRACTICE: Because of the high prevalence of cognitive impairment identified, it is important to screen cognitive function in adults with AML who are planning to receive chemotherapy to intervene and provide support earlier.

Extremity Exercise Program in Breast Cancer Survivors Suffering from Chemotherapy-Induced Peripheral Neuropathy: A Feasibility Pilot Study.

OBJECTIVES: To evaluate the feasibility of implementation of an extremity exercise program and to examine its preliminary effects in breast cancer survivors suffering from chemotherapy-induced peripheral neuropathy (CIPN). SAMPLE & SETTING: Thirteen breast cancer survivors from one hospital in northern Taiwan. Methods and Variables: A single group with repeated measures, and a quasi-experimental design. The intervention program was a four week, home-based extremity exercise program that was comprised of 10 skilled hand exercises and Buerger-Allen exercises. The Total Neuropathy Scale (clinical version), Functional Assessment of Cancer Therapy/Gynecologic Oncology Group, Neurotoxicity (13-Item Version), Identification Pain Questionnaire, and pain Visual Analogue Scale were used to measure CIPN before exercise (T1), during (T2~T4), and after exercise (T5). Qualitative data were also collected at each time point. Data were analyzed by using descriptive statistics, generalized estimating equations, and directed content analysis. RESULTS: None of the participants reported adverse events during the study period. The extremity exercise program significantly improved patient-reported CIPN after intervention at T4 or T5 but was insignificant on clinician-assessed CIPN. The qualitative data of participant experience indicated that this program is feasible and easy to follow. CONCLUSION: The extremity exercise program is feasible but needs to increase the sample size and prolong the intervention period for confirmation.

Exploring Experiences of Bereaved Caregivers of Older Adult Patients With Acute Myeloid Leukemia.

Caregivers of older adults with acute myeloid leukemia (AML) are requiring more support now that novel, nonintensive therapies, such as hypomethylating agents and venetoclax, are shifting the burden of care to the outpatient setting. Early findings from a larger study describe supportive care needs from the perspective of bereaved caregivers that align with existing research, informing the development of best practices for oncology nurses who support caregivers of older adults with AML.

Systematic Review of Cognitive Impairment in Colorectal Cancer Survivors Who Received Chemotherapy.

PROBLEM IDENTIFICATION: Cognitive impairment is a common and troublesome side effect experienced by many cancer survivors. It can have a significant impact on survivors' ability to function and enjoy a high quality of life. However, most cognitive impairment research has focused on breast cancer survivors, despite the high rates of colorectal cancer and the toxicity of treatment agents in some colorectal cancer chemotherapeutic regimens, which have been linked to cognitive impairment. This review provides a novel synthesis of what is known about cognitive impairment in colorectal cancer survivors. LITERATURE SEARCH: CINAHL®, Cochrane Library, Embase®, PsycINFO®, and PubMed® were systematically searched by a health sciences librarian. DATA EVALUATION: Data were extracted across studies; findings about the prevalence, severity, and correlates of cognitive impairment were synthesized. SYNTHESIS: Across findings from 26 articles representing 24 independent studies, 13%-57% of participants had cognitive impairment. Potential demographic, physiologic, and psychological correlates of cognitive impairment were identified. IMPLICATIONS FOR PRACTICE: Findings indicate a need to focus research and patient assessments on early identification of risk factors, assessing for existing cognitive deficits and testing interventions to decrease cognitive impairment in colorectal cancer survivors.

Use of Video Education Interventions to Increase Racial and Ethnic Diversity in Cancer Clinical Trials: A Systematic Review.

BACKGROUND: Less than 5% of eligible adult cancer survivors participate in cancer clinical trials. Survivors identifying as Black, Indigenous, and people of color (BIPOC) are less likely to participate in clinical trials compared to those identifying as non-Hispanic White. Common barriers to BIPOC participation are lack of knowledge, lack of access, and mistrust. These barriers are all factors in the disparities observed in BIPOC cancer-related morbidity and mortality. Clinical trials need adequate BIPOC representation to garner generalizable findings that can reduce or eliminate cancer disparities associated with the social construct of race. AIM: This systematic review examined the use of video education interventions to impact BIPOC survivor participation in clinical trials. METHODS: Web of Science, Embase, PubMed, Cochrane, PsycInfo, and CINAHL databases were queried for articles that described or tested video interventions aimed at increasing adult, BIPOC survivor clinical trial participation. Two authors independently screened articles for inclusion, appraised quality, and abstracted relevant data. All authors synthesized the data into themes through discussion and consensus. RESULTS: The search yielded 2,512 articles. Seven selected articles described six distinct interventions. Although the six interventions reduced barriers to participation in clinical trials, their findings varied on Black and Hispanic survivors' readiness to enroll and participate in trials. Four themes emerged: (a) cultural sensitivity is needed in video development and delivery; (b) video content should be aimed to educate and change attitudes about clinical trials; (c) video interventions are feasible and acceptable; and (d) video interventions affect outcomes on intention or actual enrollment. LINKING EVIDENCE TO ACTION: Video interventions are well-received by BIPOC survivors and may improve representation in clinical trials. Yet, video interventions are underutilized. More studies are needed to establish best practices for video interventions aimed at diversifying clinical trial participation as widening cancer disparities and rapidly changing cancer care continue to emerge.

Chemotherapy-Induced Peripheral Neurotoxicity as A Risk Factor for Poor Sleep Quality in Breast Cancer Survivors Treated with Docetaxel.

OBJECTIVE: The purpose of this study was to explore sleep quality and to determine whether chemotherapy-induced peripheral neurotoxicity is a risk factor for poor sleep quality in breast cancer survivors who receive docetaxel treatment. METHODS: Secondary data analysis from a cross-sectional study. Sample characteristics were collected using an information sheet. Independent variables included the Hospital Anxiety and Depression Scale (HADS), the Patient Neurotoxicity Questionnaire (PNQ), and the Identification Pain Questionnaire (ID pain). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). We performed descriptive analyses and simple logistic regression. RESULTS: A total of 98 participants were included. More than 60% of them reported poor sleep quality, with their average PSQI score being 7.54 ± 4.45. Poor subjective sleep quality (1.37 ± 0.88) and short sleep duration (1.37 ± 1.08) were their main problems. In addition, significant risk factors for poor sleep quality were chronic illness (odds ratio [OR] = 2.753, P = 0.041), anxiety (OR = 7.714, P = 0.009), neuropathic pain (OR = 11.261, P = 0.022), sensory neuropathy (OR = 2.529, P = 0.032), motor neuropathy (OR = 3.781, P = 0.002), and undergoing chemotherapy (OR = 2.593, P = 0.027). Targeted therapy that some survivors received served as a protective factor (OR = 0.351, P = 0.015). CONCLUSIONS: We found a high prevalence of poor sleep quality in breast cancer survivors treated with docetaxel. The results indicated that, in addition to clinical characteristics and psychological discomfort, chemotherapy-induced peripheral neurotoxicity is a significant risk factor for poor sleep quality.

Chemotherapy-induced peripheral neuropathy in newly diagnosed breast cancer survivors treated with taxane: a prospective longitudinal study.

PURPOSE: This study aimed to prospectively explore severity and prevalence of chemotherapy-induced peripheral neuropathy (CIPN) and examine the correlation between clinician-assessed (objective) and patient-reported (subjective) CIPN in breast cancer survivors receiving taxane. METHODS: This was a prospective, longitudinal study. Purposive sampling was adapted to enroll women newly diagnosed with breast cancer and about to receive taxane. The CIPN was assessed after breast cancer diagnosed and before chemotherapy (T1), before cycle 1 to 4 taxane infusion (T2 to T5), and after chemotherapy completion (T6 to T8). Total Neuropathy Score-clinical version (TNSc), Identification Pain Questionnaire (ID pain), Functional Assessment of Cancer Therapy-Taxane subscale (FACT-Tax), and Peripheral Neuropathy Scale (PNS) were utilized for measuring CIPN. Descriptive statistics, Pearson correlation coefficient, and generalized estimating equation were used to analyze data. RESULTS: A total of 88 participants were included. Both clinician-assessed and patient-reported CIPN gradually increased between T1 and T6 and mildly decreased at T7 and T8. Fifty-five participants (62.5%) experienced CIPN at T8. Weak-to-moderate correlations between subjective and objective CIPN were found at T6 to T8 (r = 0.272-0.533, p < 0.05). The change of TNSc, FACT-Tax, and PNS were significant over time. However, the significant change of neuropathic pain was only found at T6. CONCLUSION: The change of CIPN prevalence and severity were significant over time in survivors newly diagnosed with breast cancer. Specifically, the severest and highest CIPN was detected at chemotherapy completion. Survivors remained suffering from CIPN 3 months after chemotherapy completion. Besides, mild to moderate correlations between clinician-assessed and patient-reported CIPN were identified.

Oral adherence in adults with acute myeloid leukemia (AML): results of a mixed methods study.

INTRODUCTION: The incidence of AML is increasing, in part due to an aging population. Since 2017, eight novel agents have been introduced, 6 of which are oral: midostaurin, enasidenib, ivosidenib, gilteritinib, glasdegib, and venetoclax. With an increase in oral medications (OMs), patients face associated side effects that accompany OMs, which often decreases adherence. We aimed to identify and summarize adherence to OMs in this population. METHODS: Our mixed method design used focus groups (FG) and patient surveys. After IRB approval, 11 patients and 4 caregivers participated in 4 FGs. Themes from the FGs were used to develop a 37-item OMs adherence needs assessment. Participants were recruited and consented at three cancer centers to complete surveys (online, at the clinic, hospital, or from home). RESULTS: A total of 100 patients completed OMs survey. The number of pills to be taken was the most frequent and troublesome challenge. The most frequently reported interventions that would improve patient adherence were smaller pills, easier packaging, and scheduling assistance. Nearly 33% of patients indicated they skip OMs dose altogether when they forget to take it. Younger patients (< 65 years) were more accepting of taking oral compared with intravenous medications (p = .03). CONCLUSION: This study represents the first assessment of OMs adherence in adults with AML. Findings provide the basis for further exploration of interventions to enhance and increase adherence to OMs regimens.

Understanding Barriers to Oral Therapy Adherence in Adults With Acute Myeloid Leukemia.

Acute myeloid leukemia (AML) is a disease of older adults, with a median age at diagnosis of 68 years. The availability of oral anticancer medications has increased, although the standard treatment for AML remains in intravenous form. We aim to identify barriers to adherence to oral medications in patients with AML and proposed solutions for improvements. Following institutional review board approval, patients with AML and their caregivers were recruited to participate in focus groups. Sessions were digitally recorded, transcribed verbatim, and analyzed for thematic content using Dedoose qualitative software. 11 patients (five < 65 years; six ≥ 65 years) and 4 caregivers participated in these sessions. Three central themes emerged: 1) medication adherence challenges, 2) managing an oral adherence plan, and 3) strategies to improve oral adherence. Participants recommended written schedules, taking medications around meals, and using pillboxes and alarms. We believe that patients are an important source of insight into barriers and solutions to oral medication adherence.

Taxane-Induced Peripheral Neuropathy: Objective and Subjective Comparison Between Paclitaxel and Docetaxel in Patients With Breast Cancer.

BACKGROUND: Taxane-induced peripheral neuropathy (TIPN) is caused by the neurotoxicity of paclitaxel and docetaxel, but the differences between paclitaxel- and docetaxel-induced peripheral neuropathy are understudied. OBJECTIVES: The purpose of this study is to compare TIPN between docetaxel and paclitaxel in patients with breast cancer and to examine the consistency of measuring TIPN between researchers and patients. METHODS: Secondary data were analyzed from a cross-sectional study that included 64 patients with breast cancer from two teaching hospitals in Taiwan. Objective and subjective TIPN were measured. FINDINGS: Results indicated significant differences in objective TIPN, sensory sum score, and motor sum score between groups. No significant difference was detected in subjective TIPN between groups.