与癌症相关的认知功能障碍--临床实践叙事回顾。

IF 2 4区 医学 Q3 ONCOLOGY Oncology Research and Treatment Pub Date : 2024-01-01 Epub Date: 2024-03-12 DOI:10.1159/000538277
Oliver Rick, Alexandra Gerhardt, Georgia Schilling
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引用次数: 0

摘要

背景癌症相关认知功能障碍(CRCD)是癌症患者的主要功能障碍。多达 60% 的患者在接受肿瘤治疗后会出现这种中枢神经功能障碍,通常会严重影响患者的生活质量,并严重妨碍患者参与工作生活。因此,CRCD 的诊断和治疗至关重要。摘要:在德国,由于缺乏诊断和治疗指南,CRCD 在临床实践中没有得到足够的重视。该病的病理生理学非常复杂,不能仅靠化疗来解释。除了肿瘤疾病本身和肿瘤治疗外,焦虑、抑郁和睡眠障碍等心理因素也起着重要作用。如今人们已经知道,除了年龄因素外,分子遗传变化也会对认知功能产生影响。从形态上看,CRCD 可位于额叶皮层和海马体。除了视觉类比量表(VAS)等简便易行的筛查工具外,还有一些经过验证的问卷,如德国开发的 "主观感受到的注意力缺陷问卷"(FEDA)。通过这些方法可以证实疑似诊断,并将患者转介到进一步的神经学、神经心理学或肿瘤心理学诊断中。在进一步神经心理诊断的框架内,国际认知与癌症工作组(ICCTF)建议对学习、记忆、处理速度和执行功能进行测试。作者认为,为了避免过度诊断,建议采取逐步诊断的方法。在临床实践中,根据 "不良事件通用术语标准"(CTCAE 5.0 版)进行分级适用于评估严重程度。认知训练应以行为为导向,包括定期练习认知技能,以恢复注意力、精神运动速度、记忆力和执行功能。目前发现的最佳证据是患者可在家中使用的网络培训计划。正念训练和体育锻炼也有相关证据。目前,这三种治疗方法的结合似乎是治疗 CRCD 的最佳策略:认知功能障碍应在癌症患者的临床治疗中得到更多关注。目前已有相关诊断工具和循证治疗干预措施。今后,应建立网络,以便更好地护理 CRCD 患者。
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Cancer-Related Cognitive Dysfunction: A Narrative Review for Clinical Practice.

Background: Cancer-related cognitive dysfunction (CRCD) is a major functional disorder in patients with cancer. This central nervous dysfunction is found in up to 60% of patients after tumour therapy, often significantly limits the quality of life, and significantly impedes participation in working life. For this reason, diagnosis and treatment of CRCD are of central importance. This narrative review is intended to provide an overview and support for practical clinical care with regard to diagnostics and therapeutic options.

Summary: In Germany, CRCD has received insufficient attention in clinical practice due to the lack of guidelines for diagnosis and therapy. The pathophysiology is complex and cannot be explained by chemotherapeutic treatment alone. In addition to the tumour disease as such and the tumour therapy, psychological factors such as anxiety and depression as well as sleep disorders also play a significant role. Today, it is known that in addition to age, molecular genetic changes also have an effect on cognitive function. Morphologically, CRCD can be located in the frontal cortex and hippocampus. In addition to easy-to-use screening instruments such as the visual analogue scale, validated questionnaires such as the Questionnaire of Subjectively Experienced Deficits in Attention (FEDA) developed in Germany are also available. These allow the suspected diagnosis to be substantiated and the patient to be referred to further neurological, neuropsychological, or psycho-oncological diagnostics. Within the framework of further neuropsychological diagnostics, the International Cognition and Cancer Task Force (ICCTF) recommends testing learning, memory, processing speed, and executive functions. From the authors' point of view, a step-by-step diagnosis is recommended in order to avoid overdiagnosis. In clinical practice, graduation according to the "Common Terminology Criteria for Adversity Events" (CTCAE Version 5.0) is suitable for assessing the degree of severity. Cognitive training should be behaviourally oriented and include regular practice of cognitive skills to restore attention, psychomotor speed, memory, and executive functions. The best evidence is currently found for web-based training programmes that can be used by the patient at home. There is also evidence for mindfulness training and physical exercises. In particular, the combination of these three therapeutic elements currently seems to be the optimal treatment strategy for CRCD.

Key messages: Cognitive dysfunction should be given much more attention in the clinical care of cancer patients. Diagnostic tools for this purpose and evidence-based therapeutic interventions are available. In the future, networks should be created that allow for better care of patients with CRCD.

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来源期刊
CiteScore
3.20
自引率
0.00%
发文量
84
期刊介绍: With the first issue in 2014, the journal ''Onkologie'' has changed its title to ''Oncology Research and Treatment''. By this change, publisher and editor set the scene for the further development of this interdisciplinary journal. The English title makes it clear that the articles are published in English – a logical step for the journal, which is listed in all relevant international databases. For excellent manuscripts, a ''Fast Track'' was introduced: The review is carried out within 2 weeks; after acceptance the papers are published online within 14 days and immediately released as ''Editor’s Choice'' to provide the authors with maximum visibility of their results. Interesting case reports are published in the section ''Novel Insights from Clinical Practice'' which clearly highlights the scientific advances which the report presents.
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