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2023 CANTAB Research Grant Winner: Assessment of cognitive function in patients of breast cancer on chemotherapy: A prospective longitudinal study at tertiary care centre in India
I, Dr Simran Kaur sincerely appreciate the CANTAB® primary research award being granted by Cambridge Cognition for 2023. I’m an Additional Professor at the Stress and Cognitive Electroimaging Lab, Department of Physiology at All India Institute of Medical Sciences (AIIMS), New Delhi, India. I achieved my MBBS and MD (Physiology) from Maulana Azad Medical College, New Delhi. After I joined AIIMS in 2014, I initiated my research in the field of cognitive neuroscience, with the aim to non-invasively explore the neural underpinnings to establish state and trait markers in neuropsychiatric and neurodegenerative disorders. By using Quantitative EEG, our team has completed research in Addiction, ADHD, Schizophrenia, Autism etc.
Within the last 3-4 years, I started to explore cognitive deficits in cancer, with the aim to advance my research in this area. With this award, our team will be able to make substantial progress in our understanding of Chemobrain, a topic that has long been neglected and understudied, particularly in relation to India. Chemobrain, a term often used to describe the cognitive impairment experienced by cancer patients who have undergone chemotherapy, presents a complex challenge that affects the quality of life of survivors1. With the help of this grant, we will be able to conduct a focused, long-term study that will look more closely at this occurrence using a battery of tests that are standardised to Indian standards. The outcomes of our research have the potential to pave the way for better cognitive care for cancer patients, not only in India but worldwide. We thank Cambridge Cognition for supporting this vital endeavor.
Why the project is important?
Breast cancer, the most prevalent cancer globally among women, displays favourable 5-year survival rates that range from more than 90% in high-income countries to 66% in India2. With the advent of newer chemotherapeutic agents, the survivorship in breast cancer has improved significantly. This has led to emerging new challenges in terms of debilitating side effects due to chemotherapy3. Chemobrain is one of the consequences of chemotherapy induced cognitive dysfunction seen in these patients. Chemobrain refers to a range of difficulties in memory, concentration, and executive function that can emerge within weeks of the start of chemotherapy and can persist thereafter in up to 75% of patients1. According to the International Cognition and Cancer Task Force (ICCTF), deficits are mostly seen in learning, memory, processing speed, and executive function4.
Further, there occurs discordance between the subjective dysfunction as experienced by patient and objective assessment5,6. Chemotherapy induced cognitive deficits (CICD) are classified as one of the most debilitating sequelae which precludes the patients from resuming their pre-cancer life and impair their quality of life. This can cause significant distress in professional reintegration and interpersonal relationships of the patient, causing psychosocial and financial burden on the society3. The data is inconspicuous related to Indian settings, and thus, making Chemobrain an urgent yet unmet need which needs to be further explored.
What are you hoping to discover?
The research outcome from the project will help to delineate the type and timeline of cognitive deficits in patients of cancer with chemotherapy. Further the ‘at risk’ group of patients/ time points can be provided cognitive rehabilitation to improve and restore the cognitive functions using a structured yet individualized protocol, enabling the patients to lead productive lives henceforth. Thus, a model of care can be developed for the patients for awareness regarding the need for assessment of cognition and timely interventions for cognitive deficits, if required. There is inconspicuous absence of this literature in India and the cut offs need to be established regarding the Indian subpopulation.
Which CANTAB® tests will you use?
A number of the CANTAB® tasks will be used targeting the domains of visual memory, verbal memory, processing speed, executive function and cognitive flexibility. The tests include: Reaction Time (RTI):, Paired Associates Learning (PAL), Spatial Working Memory (SWM),Multitasking Test (MTT) and Rapid Visual Information Processing (RVP).
How important was funding from Cambridge Cognition for your work?
The acknowledgement of this research question, the financial assistance and cognitive tests provided by Cambridge Cognition will provide us a steppingstone to address an unmet need in cancer survivorship. With this grant, we will embark on a comprehensive research journey that includes the development of a neuropsychological assessment battery tailored specifically to Indian norms. This battery will be crucial in accurately diagnosing and understanding the cognitive deficits associated with chemotherapy in Indian patients. Our approach ensures that the tools we use are not merely translations of Western instruments but are fully adapted to the Indian cultural and linguistic milieu.
Connect with Simran Kaur
References
1. Ahles TA, Saykin AJ. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Cancer. 2002 Dec;3 Suppl 3:S84-90. doi: 10.3816/cbc.2002.s.018. PMID: 12533268.
2.https://www.who.int/initiatives/global-breast-cancer-initiative/breast-cancer-inequities
3. Onzi GR, D’Agustini N, Garcia SC, Guterres SS, Pohlmann PR, Rosa DD, Pohlmann AR. Chemobrain in Breast Cancer: Mechanisms, Clinical Manifestations, and Potential Interventions. Drug Saf. 2022 Jun;45(6):601-621. doi: 10.1007/s40264-022-01182-3. Epub 2022 May 23. PMID: 35606623.
4. Wefel JS, Vardy J, Ahles T, Schagen SB. International cognition and cancer task force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol. 2011; 12(7): 703-708
5. Savard J, Ganz PA. Subjective or objective measures of cognitive functioning – what’s more important? JAMA Oncol. 2016; 2(10): 1263-1264.
6. Vayyat, S., Revand, R., Rastogi, S., Sharma, R., & Kaur, S. (2024). Patient-reported cognitive impairments and objective neuropsychological deficits in young sarcoma patients undergoing chemotherapy and its comparison to healthy controls: A tertiary health care study from India. International Journal of Cancer, 154(8), 1413-1422. https://doi.org/10.1002/ijc.34818
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