Vaping linked to cancer-related cognitive impairment among young adult cancer survivors
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Key takeaways:
- One in eight young-adult childhood cancer survivors experienced cancer-related cognitive impairment.
- Survivors with cancer-related cognitive impairment had 2.26-higher odds of vaping.
Vaping appeared associated with cancer-related cognitive impairment among a cohort of young adult childhood cancer survivors, according to research in JCO Oncology Practice.
Researchers recommended increased access to long-term follow-up clinics and monitoring and educating young survivors about vaping and other substance use behaviors to improve long-term health of this patient population.
Rationale and methodology
“Care plan management of long-term young adult survivors of childhood cancer can be more complex as they navigate adulthood and risks for developing other health issues throughout their lifespan,” Alexandre Chan, PharmD, MPH, FCCP, professor in the department of clinical pharmacy practice and the division of hematology and oncology at University of California, Irvine, told Healio. “Our previous research has shown that cancer-related cognitive impairment is highly prevalent among childhood, adolescent and young adult cancer survivors, and can range between 10% and 40% of all young adult childhood cancer survivors. Unfortunately, there is a lack of effective treatment to manage cancer-related cognitive impairment, making management extremely challenging in clinical practice.”
The study included data from the Project Forward Cohort on 1,106 young adult childhood cancer survivors (median age, 25.5 years; 50.8% women; 51.5% Hispanic).
Chan and colleagues sought to assess the association between cancer-related cognitive impairment and substance use, including tobacco, binge drinking, marijuana, prescription drug misuse and e-cigarette/vaping. They additionally performed mediation analysis to determine opportunities for intervention.
Findings
Results showed 13% of survivors reported cancer-related cognitive impairment, with the highest prevalence observed among survivors of central nervous system tumors (25.4%) and leukemia (13.3%).
After adjusting for covariates, researchers found an association of cancer-related cognitive impairment with 2.26 times (95% CI, 1.24-4.11) higher odds of prior 30-day vaping.
Mediators with significant indirect effects in the association between cancer-related cognitive impairment and vaping included depressive symptoms and having two or more cancer-related late adverse effects (P = .05).
“Our findings suggest that young adult survivors of childhood cancers face substantial challenges in coping with their cognitive and related complications, as well as poor mental health, potentially leading to self-medication with vaping to improve concentration,” Chan said.
Implications
Cancer-related follow-up visits present excellent opportunities for oncologists and other clinicians to correct misconceptions and address physical and mental health issues that may facilitate the uptake of vaping behavior, Chan told Healio.
“Interventions that encourage engagement in long-term cancer-related follow-up care visits through a survivor-focused care model that targets unmet health and psychosocial needs of survivors will also help with reducing vaping and other substance use behaviors,” he said. “To better manage cognitive and related complications, many efforts are needed to evaluate potential underlying targets, which are still poorly known at this time.”
Chan said research is ongoing to demonstrate that augmentation of brain-derived neurotrophic factor is a viable strategy to mitigate cognitive and related complications.
“We are also conducting a clinical trial to evaluate the potential use of an integrative oncology modality, known as electroacupuncture, to manage complex co-occurring symptoms such as cancer-related cognitive impairment, depression, anxiety and fatigue,” he said.
For more information:
Alexandre Chan, PharmD, MPH, FCCP, can be reached at a.chan@uci.edu.
Perspective
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Michael B. Steinberg, MD, MPH, FACP
The study by Ng and colleagues describes the increased rates of vaping among young adult cancer survivors who self-reported cancer-related cognitive impairment (CRCI). Data came from the Project Forward Cohort and included 1,106 young adult childhood cancer survivors (median age, 25.5 years). Results showed 13% of survivors reported cancer-related cognitive impairment, with the highest prevalence observed among survivors of central nervous system tumors (25.4%) and leukemia (13.3%). After adjusting for covariates, researchers found an association of CRCI with 2.26 (95% CI, 1.24-4.11) times higher odds of prior 30-day vaping, with the rates of CRCI being 12.5% among those who vaped vs. 6.3% among those who did not.
Although vaping among young adults is a highly prevalent behavior and one in which new health effects are still being discovered on a regular basis, there are some factors in this study that make the results a bit uncertain. First, CRCI was defined as self-reported difficulties with learning and memory as a problem at the time of survey. It is unclear if all of the factors that could influence this self-reported condition are accounted for. Second, vaping was defined as any use in the prior 30 days. Someone who vaped one time, 30 days prior, is included in the same way as someone who vapes throughout the day on a daily basis.
Third, the vaping question was added after the study was initiated and thus, there are many missing data for this variable. Finally, CRCI also was related to lower education and being a student. We know that tobacco use is related to education level, and many students use vaping products. However, it does not appear in the adjusted model that education or student-status were controlled for.
Despite these limitations, vaping remains a behavior that is prevalent among young adults and youth, and it should be monitored closely. Evaluating the impact of vaping on cardiovascular, pulmonary and cognitive outcomes needs to be continued.
Physicians play an important role in communicating with patients the potential harms of electronic cigarettes. However, misperceptions exist regarding the harm of certain components found in e-cigarettes, such as nicotine, and these misperceptions need to be addressed in order to accurately communicate the risk of these products. Continuing to treat all tobacco use among cancer survivors remains a priority for NCI and should be implemented routinely in all levels of cancer treatment.
References:
Steinberg MB, et al. Prev Med Rep. 2015;doi:10.1016/j.pmedr.2015.01.006.
Steinberg MB, et al. J Gen Intern Med. 2021;doi:10.1007/s11606-020-06172-8.
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