体力活动与乳腺癌化疗患者脑功能
大约75%的乳腺癌患者化疗期间出现记忆力、注意力等大脑认知功能减退，化疗完成后可能持续数年。虽然体力活动是癌症相关认知功能衰退的干预措施之一，但是将其用于化疗期间的定量分析研究极少。
2021年8月18日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表圣路易斯华盛顿大学医学院、国家癌症研究所、罗彻斯特大学医学中心、太平洋癌症研究联盟、纽约州拿骚县成功湖北岸长岛犹太医疗中心、俄亥俄州哥伦布社区肿瘤研究中心的CANTAB研究报告，定量分析了乳腺癌患者化疗前、化疗期间和化疗后体力活动量对认知功能的影响。
CANTAB (NCT01382082): Assessment of Cognitive Function in Breast Cancer and Lymphoma Patients Receiving Chemotherapy at Pre-Treatment, Post-Treatment, at Six Month Follow-Up, and Long-Term Follow-Ups
该全国多中心前瞻定群病例对照观察研究利用有氧中心纵向研究（ACLS）体力活动问卷、癌症治疗功能评定（FACT）认知功能问卷对580例I～IIIC期乳腺癌患者（年龄53.4±10.6岁）化疗前7天内（T1）、末次化疗1个月内（T2）、完成化疗6个月后（T3）与363例年龄匹配无癌对照者（年龄52.6±10.3岁）相同时间点的体力活动和认知功能进行评分。通过纵向线性混合效应模型对人口统计学因素和临床因素进行校正后分析患者与对照者体力活动随着时间变化的特征，并进一步分析化疗前和化疗期间体力活动随着时间变化对认知功能的影响。
结果，达到全国体力活动指南标准的患者比例：
T1时：33%
T2时：降至21%
T3时：升至37%
纵向线性混合效应模型分析表明，患者与对照者相比，从T1至T2的体力活动评分显著较低（全部P<0.001）。
T1时达到与未达全国体力活动指南标准的患者相比，随着时间变化，认知功能总评分和快速视觉处理评分显著较高（全部P<0.05），与对照者客观测定的认知功能变化相似。
前一个时间点中度至剧烈体力活动较多与较少的患者相比，后一个时间点认知评分显著较高（全部P<0.05），并且整个化疗期间达到与未达全国体力活动指南标准的患者相比，自我报告认知功能评分显著较高（P<0.01）。
因此，该全国多中心前瞻定群病例对照观察研究结果表明，化疗期间患者体力活动减少，完成化疗6个月后恢复至治疗前水平；不过，大多数患者体力活动仍然不足。化疗前和化疗期间保持与未保持体力活动的患者相比，完成化疗1个月内和6个月后认知功能显著较好，故化疗前和化疗期间进行体力活动可维持认知功能。
相关链接
J Clin Oncol. 2021 Aug 18. Online ahead of print.
Physical Activity Patterns and Relationships With Cognitive Function in Patients With Breast Cancer Before, During, and After Chemotherapy in a Prospective, Nationwide Study.
Salerno EA, Culakova E, Kleckner AS, Heckler CE, Lin PJ, Matthews CE, Conlin A, Weiselberg L, Mitchell J, Mustian KM, Janelsins MC.
Washington University School of Medicine in St Louis, St Louis, MO; National Cancer Institute, Rockville, MD; University of Rochester Medical Center, Rochester, NY; Pacific Cancer Research Consortium-National Cancer Institute Community Clinical Oncology Research Program (NCORP), Seattle, WA; North Shore LIJ Health System NCORP, Lake Success, NY; Columbus NCORP, Columbus, OH.
PURPOSE: Physical activity (PA) is a promising intervention for cancer-related cognitive decline, yet research assessing its use during chemotherapy is limited. This study evaluated patterns of PA before, during, and after chemotherapy in patients with breast cancer and the association between PA and cognitive function.
METHODS: In a nationwide, prospective cohort study, we assessed PA (Aerobics Center Longitudinal Study PA measure) and perceived and objectively measured cognitive functioning (Functional Assessment of Cancer Therapy-Cognitive, Delayed Match to Sample, and Rapid Visual Processing measures) at prechemotherapy (T1), postchemotherapy (T2), and 6 months postchemotherapy (T3) in patients with breast cancer and cancer-free, age-matched controls at equivalent time points. Longitudinal linear mixed-effects models (LMMs) characterized PA changes over time between patients and controls, adjusting for demographic and clinical factors. LMMs further estimated the role of prechemotherapy PA and changes in PA during chemotherapy on cognitive changes over time.
RESULTS: Patients with stage I-IIIC breast cancer (n = 580; age M [standard deviation] = 53.4 [10.6] years) and controls (n = 363; age M [standard deviation] = 52.6 [10.3] years) were included. One third of patients met national PA guidelines at T1, dropping to 21% at T2 before rising to 37% at T3. LMMs revealed declines in PA from T1 to T2 in patients compared with controls (all P < .001). Patients meeting guidelines at T1 demonstrated better cognitive scores over time on the Functional Assessment of Cancer Therapy-Cognitive and Rapid Visual Processing (all P < .05), with similar patterns of objectively-measured cognitive function as controls. In patients, greater moderate-to-vigorous PA at the previous time point was significantly associated with better cognitive trajectories (all P < .05), and adherence to PA guidelines throughout chemotherapy was associated with better self-reported cognition (P < .01).
CONCLUSION: This nationwide study demonstrates that PA maintenance before and during chemotherapy is associated with better cognitive function immediately and 6 months after chemotherapy completion.
KEY OBJECTIVE: Cancer-related cognitive decline is an important clinical problem for which interventions are needed. Physical activity (PA) is a promising intervention; however, its use in patients undergoing active treatment is limited. This study sought to investigate timing and dose of PA in a large nationwide, prospective cohort study in patients with breast cancer as well as its relationship to cognitive function. To our knowledge, this is one of the largest analyses of PA and cognitive function before and after chemotherapy in patients with breast cancer.
KNOWLEDGE GENERATED: PA in patients declined during chemotherapy before recovering to pretreatment levels 6 months after chemotherapy completion; however, most patients remained insufficiently active. More PA prechemotherapy, and adhering to national PA guidelines during chemotherapy, were associated with better cognition over time.
RELEVANCE: This study supports the use of PA before and during chemotherapy for maintaining cognitive function.
PMID: 34406822
DOI: 10.1200/JCO.20.03514