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Objective: Informal family caregivers provide critical support for patients receiving chimeric antigen receptor (CAR) T‐cell therapy. However, caregivers' experiences are largely unstudied. This study examined quality of life (QOL; physical functioning, pain, fatigue, anxiety, and depression), caregiving burden, and treatment‐related distress in caregivers in the first 6 months after CAR T‐cell therapy, when caregivers were expected to be most involved in providing care. Relationships between patients' clinical course and caregiver outcomes were also explored. Methods: Caregivers completed measures examining QOL and burden before patients' CAR T‐cell therapy and at days 90 and 180. Treatment‐related distress was assessed at days 90 and 180. Patients' clinical variables were extracted from medical charts. Change in outcomes was assessed using means and 99% confidence intervals. Association of change in outcomes with patient clinical variables was assessed with backward elimination analysis. Results: A total of 99 caregivers (mean age 59, 73% female) provided data. Regarding QOL, pain was significantly higher than population norms at baseline but improved by day 180 (p <.01). Conversely, anxiety worsened over time (p <.01). Caregiver burden and treatment‐related distress did not change over time. Worsening caregiver depression by day 180 was associated with lower patient baseline performance status (p <.01). Worse caregiver treatment‐related distress at day 180 was associated with lower performance status, intensive care unit admission, and lack of disease response at day 90 (ps < 0.01). Conclusions: Some CAR T‐cell therapy caregivers experience pain, anxiety, and burden, which may be associated patients' health status. Further research is warranted regarding the experience of CAR T‐cell therapy caregivers. [ABSTRACT FROM AUTHOR]

Chimeric antigen receptor T‐cell therapy with axicabtagene ciloleucel (axi‐cel) has considerably improved survival in adults with relapsed/refractory large B‐cell lymphoma. This study reports patient‐reported outcomes (PROs) such as quality of life (QOL) and toxicity in the first 90 days after treatment. Hematologic cancer patients treated with axi‐cel (N = 103, mean age = 61, 39% female) completed SF‐36 or PROMIS‐29 QOL questionnaires prior to treatment and 90 days after. PRO‐Common Terminology Criteria for Adverse Events toxicity items were completed by patients at baseline and 14, 30, 60, and 90 days after treatment. Mixed models examined change in PROs over time. From preinfusion to 90 days later, patients reported improvements in physical functioning, pain, and fatigue (ps < 0.01), but worsening of anxiety (p = 0.02). Patient‐reported toxicities worsened by day 14 with improvement thereafter. The five most severe symptoms at day 14 included fatigue, decreased appetite, dry mouth, diarrhea frequency, and problems with concentration. Results indicate improvement in some domains of QOL over time with transient patient‐reported toxicities. [ABSTRACT FROM AUTHOR]

BACKGROUND Neurosurgical resection and whole-brain radiation therapy (WBRT) are accepted treatments for single and oligometastatic cancer to the brain. To avoid the decline in neurocognitive function (NCF) linked to WBRT, the authors conducted a prospective, multicenter, phase 2 study to determine whether surgery and carmustine wafers (CW), while deferring WBRT, could preserve NCF and achieve local control (LC). METHODS NCF and LC were measured in 59 patients who underwent resection and received CW for a single (83%) or dominant (oligometastatic, 2 to 3 lesions) metastasis and received stereotactic radiosurgery (SRS) for tiny nodules not treated with resection plus CW. Preservation of NCF was defined as an improvement or a decline ≤1 standard deviation from baseline in 3 domains: memory, executive function, and fine motor skills, evaluated at 2-month intervals. RESULTS Significant improvements in executive function and memory occurred throughout the 1-year follow-up. Preservation or improvement of NCF occurred in all 3 domains for the majority of patients at each of the 2-month intervals. NCF declined in only 1 patient. The chemowafers were well tolerated, and serious adverse events were reversible. There was local recurrence in 28% of the patients at 1-year follow-up. CONCLUSIONS Patients with brain metastases had improvements in their cognitive trajectory, especially memory and executive function, after treatment with resection plus CW. The rate of LC (78%) was comparable to historic rates of surgery with WBRT and superior to reports of WBRT alone. For patients who undergo resection for symptomatic or large-volume metastasis or for tissue diagnosis, the addition of CW can be considered as an option. Cancer 2013;119:3830-3838. © 2013 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies suggest that patients with cancer who undergo hematopoietic cell transplantation (HCT) are at risk for cognitive deficits. To date, little research has investigated the cumulative effects of clinical risk factors on cognitive function in patients who undergo HCT. METHODS: Patients (N = 278) who were scheduled to undergo HCT for hematologic disease completed neuropsychological assessments before HCT and at 6 months and 12 months after HCT. A time-varying cumulative clinical risk variable was examined as a predictor of total neuropsychological performance (TNP). Cumulative clinical risk was calculated from pre-HCT neuropsychological risk factors (eg, history of cranial irradiation, intrathecal chemotherapy), HCT-related risk factors (eg, allogeneic transplantation, unrelated donor), and post-HCT complications (eg, severity of mucositis and enteritis, graft-versus-host disease). RESULTS: Patients with greater cumulative clinical risk displayed worse TNP at baseline and at 6 months after HCT and less neuropsychological recovery over time than patients who had less risk ( Ps < .05). Greater cumulative clinical risk predicted worse performance on tasks assessing executive function at baseline and 6 months after HCT and assessing memory at 6 months and 12 months after HCT ( Ps < .05). Among risk variables, length of hospital stay was the only significant predictor of neuropsychological function ( P < .05). CONCLUSIONS: Findings from this study indicated that clinical risk factors may have a cumulative effect on cognitive function in patients who undergo HCT. Patients who have a complicated clinical course should be referred for evaluation and management of cognitive deficits. Cancer 2011. © 2011 American Cancer Society. [ABSTRACT FROM AUTHOR]

The article focuses on a study that examined changes in multiple domains of cognitive functioning of hematopoietic stem cell transplantation (HSCT) candidates tested pretransplantation, 6 months posttransplantation and 12 months posttransplantation. It indicates that the performance on cognitive abilities, except of attention, significantly improved across the 1-year follow-up period after HSCT. It cites the measures used to assess memory.

Objective: To determine prevalence of alcohol abuse and dependency, depression, and cognitive impairment in presurgical head and neck cancer patients. Study design: Standardized testing by diagnostic interview was used to determine major depression and alcoholism. Mattis Dementia Rating Scale examined cognitive ability preoperatively. Twenty-four patients with advanced head and neck cancer participated. Setting: University hospital. Results: A total of 63.6% met criteria for alcohol abuse and 62 percent for alcohol dependence; 26.1 % of patients met criteria for major depression. Testing in multiple subsets of cognitive function demonstrated measurable deficits in both alcohol dependents and abusers. All deficits were significant when compared with population norms. Conclusions: Findings suggest that prevalence of alcohol abuse, major depression, and cognitive impairment is common in head and neck cancer patients preoperatively. Early diagnosis and management of these disorders should be considered in care of the head and neck cancer patient. [Copyright &y& Elsevier]

The Distress Thermometer (DT) is a one-item screening measure of psychological distress in cancer patients. This study examines the operating characteristics of the DT in patients about to undergo bone marrow transplant (BMT). Patients (N=491) completed the DT, the Center for Epidemiological Studies-Depression Scale (CES-D), the State-Trait Anxiety Inventory-State Version (STAI-S), the ECOG Performance Status Scale, and the Patient Problem List. DT scores were related to higher depression, higher anxiety, and poorer performance status. Receiver operating characteristic (ROC) curve analyses of DT scores yielded area under the curve estimates of 0.75 when compared to the CES-D cutoff score of 16, suggesting the DT has acceptable overall accuracy. The DT cutoff score of 4 had the greatest sensitivity and specificity when compared to the CES-D cutoff score. Patients above this cutoff score reported worse ECOG scores and more practical, family, emotional, and physical problems (all p's&les;0.05) than those below the cutoff. The findings suggest the DT is a useful tool for screening for distress in BMT patients. The optimal DT cutoff score of 4 found here was identical to that found in another study using different criteria. This cutoff score also identified patients with problems likely to reflect psychological distress. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]