title: Psychologic and neuropsychologic functioning of patients with limited small-cell lung cancer treated with chemotherapy and radiation therapy with or without warfarin: a study by the Cancer and Leukemia Group B.
abstract: OBJECTIVE
  The current study assessed the psychologic and neuropsychologic functioning of patients with small-cell lung cancer who were randomized in a large clinical trial to receive intensive doxorubicin, cyclophosphamide, etoposide (ACE)/cisplatin, cyclophosphamide, etoposide (PCE) chemotherapy and radiation therapy (RT) to the primary tumor and prophylactic whole-brain irradiation with (regimen I) or without (regimen II) warfarin.
  
  
  METHODS
  Patients' emotional states and cognitive functioning were assessed using the Profile of Mood States (POMS) and Trail Making B Test (Trails B), respectively. Two hundred ninety-five patients completed the POMS and Trails B at pretreatment, 224 patients after the completion of the ACE course of chemotherapy (week 9), and 177 patients after the completion of the PCE chemotherapy and RT (week 17).
  
  
  RESULTS
  No differences on the POMS or Trails B measures were found between the two treatment arms as predicted, given that the only difference between the two treatment arms was the presence or absence of warfarin. Analysis of the POMS revealed that, overall, mean scores remained stable over the course of treatment; however, women showed a trend toward higher mean scores, which indicated a higher level of distress, compared with men at the pretreatment assessment. Examination of cognitive functioning, measured by the Trails B, revealed improved performance from baseline to post-ACE chemotherapy, which is consistent with a practice effect, but a significant worsening of Trails B scores post-RT compared with the pre-RT assessments, which is consistent with impaired cognitive functioning because of treatment (P < .0001).
  
  
  CONCLUSIONS
  Emotional state, measured by the POMS, did not differ between the groups or change significantly over time in this study of small-cell lung cancer patients treated with a combination of chemotherapy and RT plus or minus warfarin. However, the pattern of relatively stable POMS scores and poorer Trails B performance post-RT suggested that this combination of chemotherapy and RT had a negative impact on cognitive functioning.
authors.affiliation: Dartmouth-Hitchcock Medical Center and the Norris Cotton Cancer Center, Lebanon, NH 03756, USA. tim.a.ahles@dartmouth.edu
authors.forename: T A
authors.initials: TA
authors.lastname: Ahles
authors.forename: P M
authors.initials: PM
authors.lastname: Silberfarb
authors.forename: J
authors.initials: J
authors.lastname: Herndon
authors.forename: L H
authors.initials: LH
authors.lastname: Maurer
authors.forename: A B
authors.initials: AB
authors.lastname: Kornblith
authors.forename: J
authors.initials: J
authors.lastname: Aisner
authors.forename: M C
authors.initials: MC
authors.lastname: Perry
authors.forename: W L
authors.initials: WL
authors.lastname: Eaton
authors.forename: L L
authors.initials: LL
authors.lastname: Zacharski
authors.forename: M R
authors.initials: MR
authors.lastname: Green
authors.forename: J C
authors.initials: JC
authors.lastname: Holland
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003071:Cognition; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004644:Emotions; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D014145:Trail Making Test; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin