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  1. Article ; Online: Telemedicine in geriatric oncology - lessons learned from the COVID-19 experience.

    Cabrera Chien, Leana / Uranga, Carolina / Katheria, Vani

    Current opinion in supportive and palliative care

    2024  Volume 18, Issue 2, Page(s) 100–105

    Abstract: Purpose of review: Telemedicine quickly became integrated into healthcare caused by the Coronavirus 19 (COVID-19) pandemic. Rapid use of telemedicine into healthcare systems was supported by the World Health Organization and other prominent national ... ...

    Abstract Purpose of review: Telemedicine quickly became integrated into healthcare caused by the Coronavirus 19 (COVID-19) pandemic. Rapid use of telemedicine into healthcare systems was supported by the World Health Organization and other prominent national organizations to reduce transmission of the virus while continuing to provide access to care. In this review, we explored the effect of this swift change in care and its impact on older adults with cancer.
    Recent findings: Older adults are susceptible to the COVID-19 virus caused by various risk factors, such as comorbidity, frailty, decreased immunity, and cancer increases vulnerability to infection, hospitalization, and mortality. We found three major themes emerged in the literature published in the past 18 months, including access to care, telemedicine modes of communication, and the use of technology by older adults with cancer. These findings have brought insight into issues regarding healthcare disparities.
    Summary: The utilization of telemedicine by older adults with cancer has potential future benefits with the integration of technology preparation prior to the patient's initial visit and addressing known health disparities. The hybrid model of care provides in-person and or remote access to clinicians which may allow older adults with cancer the flexibility needed to obtain quality cancer care.
    MeSH term(s) Humans ; COVID-19/epidemiology ; Telemedicine/organization & administration ; Neoplasms/therapy ; Neoplasms/epidemiology ; Aged ; Health Services Accessibility/organization & administration ; Medical Oncology/organization & administration ; SARS-CoV-2 ; Healthcare Disparities ; Geriatrics/organization & administration ; Pandemics
    Language English
    Publishing date 2024-04-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2633726-5
    ISSN 1751-4266 ; 1751-4258
    ISSN (online) 1751-4266
    ISSN 1751-4258
    DOI 10.1097/SPC.0000000000000697
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  2. Article ; Online: Cognitive effects of long-term androgen deprivation therapy in older men with prostate cancer.

    Pergolizzi, Denise / Flaherty, Kathleen R / Saracino, Rebecca M / Root, James C / Schofield, Elizabeth / Cassidy, Caroline / Katheria, Vani / Patel, Sunita K / Dale, William / Nelson, Christian J

    Psycho-oncology

    2024  Volume 33, Issue 3, Page(s) e6336

    Abstract: Objective: Androgen deprivation therapy (ADT) is a common treatment for prostate cancer (PCa), with increasing numbers of men on ADT for longer. Limited evidence suggests ADT impacts cognition. This study addressed gaps in the literature by focusing on ... ...

    Abstract Objective: Androgen deprivation therapy (ADT) is a common treatment for prostate cancer (PCa), with increasing numbers of men on ADT for longer. Limited evidence suggests ADT impacts cognition. This study addressed gaps in the literature by focusing on older men with PCa and assessing ADT usage longer than 1 year.
    Methods: This study of 133 men ≥65 years of age with PCa included two groups: (1) men on ADT for 1-3 years (ADT-exposed), and (2) a comparison group of men with PCa not on ADT (ADT-unexposed). Group comparisons on individual neuropsychological test scores are reported, as well as effect sizes (Cohen's d).
    Results: Half (n = 67) of the sample was ADT-exposed and half (n = 66) were unexposed. The average age was 72 years, most were White, and over 50% had at least secondary education. There were no statistically significant differences between groups by age, race, or education. Unadjusted analyses showed the ADT-exposed group, compared with the ADT-unexposed group, performed significantly lower in domains of verbal learning (d = 0.45-0.52, p = 0.01 to <0.01), verbal recall (d = 0.33-0.54, p = 0.06 to <0.01), and possible effects in visuospatial construction (d = 0.33, p = 0.08 to 0.06). When controlling for age and education, similar patterns emerged. The ADT exposed-group performed significantly lower in domains of verbal learning (d = 0.45-0.52, p = 0.06 to 0.03) and verbal recall (d = 0.33-0.54, p = 0.11 to 0.03), and possible effects in visuospatial construction d = 0.33, p = 0.18 to 0.13.
    Conclusions: This study suggests long-term ADT exposure impacts verbal learning, verbal recall, and possibly visuospatial abilities in older men (≥65) with PCa. The potential cognitive effects of ADT should be discussed with older patients considering long-term use of ADT.
    MeSH term(s) Male ; Humans ; Aged ; Infant ; Child, Preschool ; Prostatic Neoplasms/drug therapy ; Prostatic Neoplasms/psychology ; Androgen Antagonists/adverse effects ; Androgens ; Cognition
    Chemical Substances Androgen Antagonists ; Androgens
    Language English
    Publishing date 2024-03-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 1118536-3
    ISSN 1099-1611 ; 1057-9249
    ISSN (online) 1099-1611
    ISSN 1057-9249
    DOI 10.1002/pon.6336
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    Zs.A 3550: Show issues Location:
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  3. Article ; Online: Outcome prioritization and preferences among older adults with cancer starting chemotherapy in a randomized clinical trial.

    Soto-Perez-de-Celis, Enrique / Dale, William / Katheria, Vani / Kim, Heeyoung / Fakih, Marwan / Chung, Vincent M / Lim, Dean / Mortimer, Joanne / Cabrera Chien, Leana / Charles, Kemeberly / Roberts, Elsa / Vazquez, Jessica / Moreno, Jeanine / Lee, Ty / Fernandes Dos Santos Hughes, Simone / Sedrak, Mina S / Sun, Can-Lan / Li, Daneng

    Cancer

    2024  

    Abstract: Introduction: Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy.: Methods: Secondary analysis of a ... ...

    Abstract Introduction: Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy.
    Methods: Secondary analysis of a randomized trial addressing vulnerabilities in older adults with cancer. Patients completed three validated outcome prioritization tools: 1) Health Outcomes Tool: prioritizes outcomes (survival, independence, symptoms) using a visual analog scale; 2) Now vs. Later Tool: rates the importance of quality of life at three times-today versus 1 or 5 years in the future; and 3) Attitude Scale: rates agreement with outcome-related statements. The authors measured the proportion of patients prioritizing various outcomes and evaluated their characteristics.
    Results: A total of 219 patients (median [range] age 71 [65-88], 68% with metastatic disease) were included. On the Health Outcomes Tool, 60.7% prioritized survival over other outcomes. Having localized disease was associated with choosing survival as top priority. On the Now vs. Later Tool, 50% gave equal importance to current versus future quality of life. On the Attitude Scale, 53.4% disagreed with the statement "the most important thing to me is living as long as I can, no matter what my quality of life is"; and 82.2% agreed with the statement "it is more important to me to maintain my thinking ability than to live as long as possible".
    Conclusion: Although survival was the top priority for most participants, some older individuals with cancer prioritize other outcomes, such as cognition and function. Clinicians should elicit patient-defined priorities and include them in decision-making.
    Language English
    Publishing date 2024-04-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1429-1
    ISSN 1097-0142 ; 0008-543X ; 1934-662X
    ISSN (online) 1097-0142
    ISSN 0008-543X ; 1934-662X
    DOI 10.1002/cncr.35333
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  4. Article ; Online: Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study.

    Sedrak, Mina S / Sun, Can-Lan / Bae, Marie / Freedman, Rachel A / Magnuson, Allison / O'Connor, Tracey / Moy, Beverly / Wildes, Tanya M / Klepin, Heidi D / Chapman, Andrew E / Tew, William P / Dotan, Efrat / Fenton, Mary Anne / Kim, Heeyoung / Katheria, Vani / Muss, Hyman B / Cohen, Harvey J / Gross, Cary P / Ji, Jingran

    Journal of cancer survivorship : research and practice

    2024  

    Abstract: Purpose: This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both.: Methods: We prospectively sampled three groups of women aged ≥ 65: 444 ...

    Abstract Purpose: This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both.
    Methods: We prospectively sampled three groups of women aged ≥ 65: 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). Physical function was assessed at two timepoints (T1 [baseline] and T2 [3, 4, or 6 months]) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form. The primary endpoint was the change in PF-10 scores from T1 to T2, analyzed continuously and dichotomously (Yes/No, with "yes" indicating a PF-10 decline > 10 points, i.e., a substantial and clinically meaningful difference).
    Results: Baseline PF-10 scores were similar across all groups. The BC Chemo group experienced a significant decline at T2, with a median change in PF-10 of -5 (interquartile range [IQR], -20, 0), while BC Control and NC Control groups showed a median change of 0 (IQR, -5, 5; p < 0.001). Over 30% of BC Chemo participants had a substantial decline in PF-10 vs. 8% in the BC Control and 5% in the NC Control groups (p < 0.001).
    Conclusion: In this cohort of older adults with early-stage breast cancer, the combination of breast cancer and chemotherapy contributes to accelerated functional decline. Our findings reinforce the need to develop interventions aimed at preserving physical function, particularly during and after chemotherapy.
    Implications for cancer survivors: The high prevalence of accelerated functional decline in older women undergoing breast cancer chemotherapy underscores the urgency to develop interventions aimed at preserving physical function and improving health outcomes.
    Clinical trial: NCT01472094, Hurria Older PatiEnts (HOPE) with Breast Cancer Study.
    Language English
    Publishing date 2024-04-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2388888-X
    ISSN 1932-2267 ; 1932-2259
    ISSN (online) 1932-2267
    ISSN 1932-2259
    DOI 10.1007/s11764-024-01594-3
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  5. Article ; Online: Patient-Defined Goals and Preferences Among Adults With Advanced Neuroendocrine Tumors.

    Li, Daneng / Sun, Can-Lan / Kim, Heeyoung / Crook, Christiana / Zhang, Ya-Han / Allen, Rebecca / Ballena, Richard / Hyder, Shadman / Koczywas, Marianna / Chung, Vincent / Lim, Dean / Katheria, Vani / Dale, William / Singh, Gagandeep

    Journal of the National Comprehensive Cancer Network : JNCCN

    2022  Volume 20, Issue 12, Page(s) 1330–1337.e3

    Abstract: Background: Patient preferences (quantity vs quality of life; present vs future health) have not been investigated in patients with neuroendocrine tumors (NETs). The goal of this cross-sectional study was to evaluate patient values toward treatment ... ...

    Abstract Background: Patient preferences (quantity vs quality of life; present vs future health) have not been investigated in patients with neuroendocrine tumors (NETs). The goal of this cross-sectional study was to evaluate patient values toward treatment goals and competing health outcomes among adults with NETs.
    Patients and methods: Patients with well-differentiated, grade 1 or 2, advanced NETs starting a new systemic therapy completed 4 tools: (1) Health Outcomes Tool, which ranks the importance of 4 outcomes (survival, function/independence, freedom from pain, freedom from symptoms); (2) Attitude Scale, which identifies the extent to which patients agree with statements related to health outcomes; (3) Now versus Later Tool, which ranks the relative importance of quality of life (QoL) now versus 1 and 5 years from now; and (4) Prognosis and Treatment Perceptions Questionnaire, which identifies the amount of information the patient prefers to receive about their disease and treatment, the patient's treatment goal, the patient's perception of the physician's treatment goal, and self-reported health status.
    Results: We recruited 60 patients with NETs (50.0% aged ≥65 years; 96.7% with stage IV disease). Primary tumor locations included the gastrointestinal tract (41.7%), pancreas (30.0%), and lung (21.7%). A plurality of patients reported maintaining independence as their most important health outcome (46.7%), followed by survival (30.0%), freedom from pain (11.7%), and freedom from symptoms (11.7%). A total of 67% of patients agreed with the statement, "I would rather live a shorter life than lose my ability to take care of myself"; 85.0% agreed with the statement, "It is more important to me to maintain my thinking ability than to live as long as possible." When asked to choose between current QoL versus QoL 1 year or 5 years in the future as more important, 48.3% and 40.0% of patients valued their QoL 1 year and 5 years in the future, respectively, more than their current QoL. Only 51.7% of patients believed their physician's treatment goals aligned with their own.
    Conclusions: Adult patients with NETs strongly value independence over survival. More communication between patients with NETs and their physicians is needed to ensure that patient preferences are incorporated into treatment plans.
    MeSH term(s) Adult ; Humans ; Neuroendocrine Tumors/therapy ; Neuroendocrine Tumors/pathology ; Quality of Life ; Cross-Sectional Studies ; Surveys and Questionnaires ; Pain
    Language English
    Publishing date 2022-12-07
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2250759-0
    ISSN 1540-1413 ; 1540-1405
    ISSN (online) 1540-1413
    ISSN 1540-1405
    DOI 10.6004/jnccn.2022.7059
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  6. Article ; Online: Using Goal Achievement as an Outcome Measure Following a Gero-Oncology Educational Program for Oncology Nurses: The GrOW Curriculum.

    Economou, Denice / Burhenn, Peggy S / Uranga, Carolina / Kim, Heeyoung / Sun, Can-Lan / Katheria, Vani / Mitani, Dale / Loscalzo, Matthew J / Hurria, Arti / Dale, William

    Oncology nursing forum

    2022  Volume 49, Issue 1, Page(s) 11–20

    Abstract: Purpose: This article describes the qualitative analysis of goal achievement by oncology nurses who attended a gero-oncology course.: Participants & setting: Four annual programs were completed and included 140 teams of oncology nurses from cancer ... ...

    Abstract Purpose: This article describes the qualitative analysis of goal achievement by oncology nurses who attended a gero-oncology course.
    Participants & setting: Four annual programs were completed and included 140 teams of oncology nurses from cancer settings across the United States.
    Methodologic approach: Self-determination theory and achievement goal theory provided the conceptual framework for understanding what motivates people to achieve goals and how goals can measure outcomes. SMART goals were used to measure outcomes and barriers.
    Findings: Goal achievement at 18 months showed that 70% of developed goals were in process or completed. The top three goal categories were professional education, structure/team building, and resource development. Top barriers included time constraints and staffing shortages.
    Implications for nursing: Encouraging oncology nurses to set specific goals while attending an educational program supports successful integration of new knowledge in their practice setting.
    MeSH term(s) Clinical Competence ; Curriculum ; Goals ; Humans ; Medical Oncology ; Oncology Nursing/education ; Outcome Assessment, Health Care ; United States
    Language English
    Publishing date 2022-05-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604886-9
    ISSN 1538-0688 ; 0190-535X ; 1538-0688
    ISSN (online) 1538-0688 ; 0190-535X
    ISSN 1538-0688
    DOI 10.1188/22.ONF.11-20
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  7. Article: Improving Care for Spanish-Speaking Older Adults with Breast Cancer: Feasibility, Reliability, and Validity of a Self-Administered Spanish Language Geriatric Assessment.

    Soto-Perez-de-Celis, Enrique / Vazquez, Jessica / Kim, Heeyoung / Sun, Can-Lan / Charles, Kemeberly / Celis, Ashley / Katheria, Vani / Li, Daneng / Dale, William / Sedrak, Mina S

    Cancers

    2021  Volume 13, Issue 11

    Abstract: We evaluated the feasibility, reliability, and validity of a Spanish-language self-administered geriatric assessment (GA) in older (age ≥ 65) Spanish-speaking women with breast cancer in the United States. Eligible participants ( ...

    Abstract We evaluated the feasibility, reliability, and validity of a Spanish-language self-administered geriatric assessment (GA) in older (age ≥ 65) Spanish-speaking women with breast cancer in the United States. Eligible participants (
    Language English
    Publishing date 2021-05-29
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers13112685
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  8. Article ; Online: Relationship between cognitive functioning and frailty in older breast cancer survivors.

    Ahles, Tim A / Schofield, Elizabeth / Li, Yuelin / Ryan, Elizabeth / Root, James C / Patel, Sunita K / McNeal, Katrazyna / Gaynor, Alexandra / Tan, Heidi / Katheria, Vani / Vazquez, Jessica / Traina, Tiffany / Hurria, Arti

    Journal of geriatric oncology

    2021  Volume 13, Issue 1, Page(s) 27–32

    Abstract: Introduction: The relationship between cognitive function and frailty in older, long-term breast cancer survivors was examined.: Materials and methods: Breast cancer survivors who were diagnosed and treated at 60 years of age or above and were 5-15 ... ...

    Abstract Introduction: The relationship between cognitive function and frailty in older, long-term breast cancer survivors was examined.
    Materials and methods: Breast cancer survivors who were diagnosed and treated at 60 years of age or above and were 5-15 year disease-free survivors and non-cancer controls matched on age and education were evaluated with neuropsychological tests and the Comprehensive Geriatric Assessment which was used to assess frailty based on a deficit accumulation frailty index (DAFI).
    Results: Unadjusted regression analyses revealed that cancer survivors scored significantly lower on the Language (P = 0.015), Attention, Processing Speed, Executive Function (APE) (P = 0.015), and Learning and Memory (LM) (P = 0.023) domains compared to controls. However, only the LM domain remained significantly different (P = 0.002) in the adjusted analysis. Survivors had significantly higher DAFI scores compared to controls (p = 0.006) and significantly more survivors were categorized as pre-frail or frail (35%) compared to controls (23%, P = 0.009). Increasing frailty scores were associated with worse cognitive performance across all domains (all Ps ≤ 0.004). For the LM domain, there was a significant interaction (P = 0.019) between DAFI score and survivorship vs control status. Survivors demonstrated a significant linear decline in LM scores as DAFI scores increased, whereas controls demonstrated comparable scores between the robust and pre-frail DAFI groups, demonstrating decline in the frailty group only.
    Conclusion: Older, long-term breast cancer survivors had lower cognitive performance and higher levels of frailty compared to controls. For the Learning and Memory domain, the decline in performance began in the pre-frail range for survivors, but not controls.
    MeSH term(s) Aged ; Breast Neoplasms/therapy ; Cancer Survivors/psychology ; Cognition ; Female ; Frail Elderly/psychology ; Frailty/complications ; Frailty/epidemiology ; Geriatric Assessment ; Humans
    Language English
    Publishing date 2021-08-05
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2556813-9
    ISSN 1879-4076 ; 1879-4068
    ISSN (online) 1879-4076
    ISSN 1879-4068
    DOI 10.1016/j.jgo.2021.07.011
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  9. Article ; Online: Falls prechemotherapy and toxicity-related hospitalization during adjuvant chemotherapy for breast cancer in older women: Results from the prospective multicenter HOPE trial.

    Ji, Jingran / Bae, Marie / Sun, Can-Lan / Wildes, Tanya M / Freedman, Rachel A / Magnuson, Allison / O'Connor, Tracey / Moy, Beverly / Klepin, Heidi D / Chapman, Andrew E / Tew, William P / Dotan, Efrat / Fenton, Mary Anne / Kim, Heeyoung / Katheria, Vani / Gross, Cary P / Cohen, Harvey J / Muss, Hyman B / Sedrak, Mina S

    Cancer

    2023  Volume 130, Issue 6, Page(s) 936–946

    Abstract: Background: Older women with breast cancer frequently experience toxicity-related hospitalizations during adjuvant chemotherapy. Although the geriatric assessment can identify those at risk, its use in clinic remains limited. One simple, low-cost marker ...

    Abstract Background: Older women with breast cancer frequently experience toxicity-related hospitalizations during adjuvant chemotherapy. Although the geriatric assessment can identify those at risk, its use in clinic remains limited. One simple, low-cost marker of vulnerability in older persons is fall history. Here, the authors examined whether falls prechemotherapy can identify older women at risk for toxicity-related hospitalization during adjuvant chemotherapy for breast cancer.
    Methods: In a prospective study of women >65 years old with stage I-III breast cancer treated with adjuvant chemotherapy, the authors assessed baseline falls in the past 6 months as a categorical variable: no fall, one fall, and more than one fall. The primary end point was incident hospitalization during chemotherapy attributable to toxicity. Multivariable logistic regression was used to examine the association between falls and toxicity-related hospitalization, adjusting for sociodemographic, disease, and geriatric covariates.
    Results: Of the 497 participants, 60 (12.1%) reported falling before chemotherapy, and 114 (22.9%) had one or more toxicity-related hospitalizations. After adjusting for sociodemographic, disease, and geriatric characteristics, women who fell more than once within 6 months before chemotherapy had greater odds of being hospitalized from toxicity during chemotherapy compared to women who did not fall (50.0% vs. 20.8% experienced toxicity-related hospitalization, odds ratio, 4.38; 95% confidence interval, 1.66-11.54, p = .003).
    Conclusions: In this cohort of older women with early breast cancer, women who experienced more than one fall before chemotherapy had an over 4-fold increased risk of toxicity-related hospitalization during chemotherapy, independent of sociodemographic, disease, and geriatric factors.
    MeSH term(s) Humans ; Female ; Aged ; Aged, 80 and over ; Breast Neoplasms/drug therapy ; Prospective Studies ; Chemotherapy, Adjuvant/adverse effects ; Geriatric Assessment/methods ; Hospitalization
    Language English
    Publishing date 2023-11-14
    Publishing country United States
    Document type Multicenter Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1429-1
    ISSN 1097-0142 ; 0008-543X ; 1934-662X
    ISSN (online) 1097-0142
    ISSN 0008-543X ; 1934-662X
    DOI 10.1002/cncr.35105
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  10. Article ; Online: The impact of APOE and smoking history on cognitive function in older, long-term breast cancer survivors.

    Ahles, Tim A / Orlow, Irene / Schofield, Elizabeth / Li, Yuelin / Ryan, Elizabeth / Root, James C / Patel, Sunita K / McNeal, Katrazyna / Gaynor, Alexandra / Tan, Heidi / Katheria, Vani / Vazquez, Jessica / Corrales-Guerrero, Sergio / Sadeghi, Keimya / Traina, Tiffany / Hurria, Arti

    Journal of cancer survivorship : research and practice

    2022  Volume 18, Issue 2, Page(s) 575–585

    Abstract: Purpose: This study aims to determine whether older breast cancer survivors score lower on neuropsychological tests compared to matched non-cancer controls and to test the hypotheses that survivors who were APOE ε4 carriers would have the lowest ... ...

    Abstract Purpose: This study aims to determine whether older breast cancer survivors score lower on neuropsychological tests compared to matched non-cancer controls and to test the hypotheses that survivors who were APOE ε4 carriers would have the lowest cognitive performance but that smoking history would decrease the negative effect of ε4 on cognition.
    Methods: Female breast cancer survivors who had been diagnosed and treated at age 60 or older and were 5-15-year survivors (N = 328) and age and education matched non-cancer controls (N = 162) were assessed at enrollment and at 8-, 16-, and 24-month follow-ups with standard neuropsychological and psychological assessments. Blood for APOE genotyping was collected, and smoking history was assessed at enrollment. Participants were purposely recruited so that approximately 50% had a history of treatment with chemotherapy or no chemotherapy and approximately 50% had a smoking history.
    Results: After adjusting for age, cognitive reserve, depression, and fatigue, breast cancer survivors scored significantly lower on all domains of cognitive function. A significant two-way interaction demonstrated that the negative effect of ε4 on cognitive performance was stronger among survivors. A significant three-way interaction supported the hypothesis that smoking history had a protective effect on cognitive function in ε4 carriers that was more pronounced in the controls than the survivors.
    Conclusions: The results support the long-term cognitive impact of breast cancer diagnosis and treatments on older, disease-free survivors, particularly for ε4 carriers. The results also emphasize the importance of assessing smoking history when examining APOE and cognition and are an example of the complex interactions of age, genetics, health behaviors, and disease history in determining cognitive function.
    Implications for cancer survivors: These results help explain why only a subset of breast cancer survivors appear to be vulnerable to cognitive problems.
    MeSH term(s) Humans ; Female ; Aged ; Middle Aged ; Genotype ; Apolipoprotein E4/genetics ; Breast Neoplasms/psychology ; Cancer Survivors ; Cognition ; Neuropsychological Tests ; Smoking/adverse effects
    Chemical Substances Apolipoprotein E4
    Language English
    Publishing date 2022-10-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2388888-X
    ISSN 1932-2267 ; 1932-2259
    ISSN (online) 1932-2267
    ISSN 1932-2259
    DOI 10.1007/s11764-022-01267-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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