Leeuwen, D.Y. van (2015) Het effect van roken op postoperatieve cognitieve dysfunctie bij oudere kanker patiënten : een retrospectieve studie. thesis, Medicine.
Full text available on request.Abstract
Introduction The cancer prevalence within the Dutch population will increase, especially within the elderly (>65) population. A total of 57 % of the cancer patients with a solid tumor receive surgical treatment. The quality of life (QoL) is of great importance after surgery and has more impact nowadays. Cognitive functioning is a significant factor that influences QoL. A cognitive complication after surgery such as postoperative cognitive dysfunction (POCD) may occur. Inflammatory response after surgery is assumed to cause POCD in elderly patients (>065). A factor that influences (neuro)inflammation is smoking. There seems to be a connection between smoking and POCD, although findings in literature remain scarce. Therefore the aim of this study was to examine the effect of smoking on POCD in elderly cancer patients. Method This is a retrospective conducted study. A cohort analyses of collected data from February 2010 until 2014 in the University Medical Centre Groningen (UMCG) from postoperative elderly cancer patients. Smoking behavior from the study population was retrospective assessed from electronic health records. Demographic, physical, operative, cognitive and stress response characteristics were analyzed in this study. Stress response was measured by analyzing inflammation markers and cortisol. There were three different cognitive domains: executive function, memory and attention. Within these domains POCD could be determined for each test by using Z-scores for each endpoint. Smokers and non-smokers were compared within the domains. Independent T-tests, Mann Whitney U test and Chi-square were used to analyze the difference between the group smokers and non-smokers of the study population. Mann Whitney U test, Chi-square (trend) and Fisher’s exact were used to analyze the difference between patients with and without POCD for each test and cognitive domain. Univariate regression analysis was used for significant different variables between patient classified as POCD patient and non-POCD patient to determine if there was an association. Results Data from 242 patients were analyzed: 71 smokers and 151 non-smokers. Significant differences between smokers and non-smokers were observed for preoperative health status and CRP. The mean age among smokers was 72 years (sd=5.9) and non-smokers was 73 years (sd=5.9). There were more male smokers (62%), then female smokers (38). No significant differences were found in age and gender. Between patients with POCD and without POCD there were significant differences in: mean age, duration in anesthesia, IL-1β and cortisol. Univariate regression analysis showed that age and cortisol are likely to cause POCD. Conclusion This study showed that smokers have higher CRP-values in comparison with non-smokers. Other stress- response values showed no significant differences between the two groups. Smokers have lower scores on cognitive domain ‘attention’ compared to non-smokers. Furthermore, patient with POCD are older and have a longer duration of anesthesia. Age and cortisol are possible predictors for POCD.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisors: and Leeuwen Dr. B.L. van en and Huisman, Drs. M.G. and Afdeling Oncologische Chirurgie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1197 |
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