Cognitive and Affective Symptoms Experienced by Cancer Patients Receiving High-Dose Intravenous Interleukin 2 Therapy

Abstract

Background Alterations in cognitive/affective functioning are among the most challenging side effects experienced by 80% of patients with metastatic melanoma and metastatic renal cell carcinoma undergoing high-dose Interleukin-2 (IL-2) therapy. Objective The purpose of this literature review is to describe what is known about IL-2—induced cognitive/affective symptoms, their prevalence and level of severity, and synthesize findings to determine areas for future research to address symptom management challenges. This review describes the IL-2 patient experience, and the pathophysiology leading to these changes. Methods An online electronic search using PubMed was performed to identify relevant literature published between 1992 and 2015. Of the original 113 manuscripts, information was extracted from nine articles regarding cognitive symptoms, affective symptoms, sample size, research design, reliability and validity. Results Our review suggests that the trajectories, breadth and depth of cognitive/affective symptoms have yet to be described. Despite intervention studies designed to address the psychosocial complications of IL-2, an understanding of the level of altered cognitive/affective symptoms experienced by IL-2 patients remains unclear. Conclusion Our literature review reveals a lack of standardization when assessing, reporting and managing cognitive/affective symptoms. Patients/family members have reported cognitive/affective symptoms to be the most alarming and difficult symptoms, yet these symptoms are not adequately screened for and patients were not informed about potential changes. Implications for Practice Assessing patients for cognitive/affective alterations is important to reduce anxiety while improving outcomes. Education about the illness trajectory (what to expect during/after treatment) can help care partners/patients set realistic shared expectations, and increase coping.

A prospective cohort study investigating contemporaneous changes in cytokines and cognitive function during chemotherapy in patients with breast cancer

“…In contrast with past literature reporting that IL-2 might underlie cognitive impairments in BC (32), we found a positive association between an increase in IL-2 and improvements in Event-based prospective memory from before to after chemotherapy. Past studies reporting negative correlations between IL-2 and cognitive performances were mostly cross-sectional (32) or case-control in design (11), and did not evaluate within-individual alterations in cognition and IL-2 during chemotherapy. In addition, there has been a lack of information on pre-and post-treatment cytokines or cognitive performance.…”

Inflammation and behavioral symptoms in preoperational glioma patients: Is depression, anxiety, and cognitive impairment related to markers of systemic inflammation?

“…And in animal experiments by Petitto, McNamara, Gendreau, Huang, and Jackson (1999), IL-2 was shown to be a marker of systemic inflammation and was associated with decreased memory and language ability. Interestingly, many studies support the results that IL-2 is positively correlated with anxiety (Mann, Dail, & Bailey, 2016). The researchers supposed that emotional changes were associated with fluid overload or brain edema caused by increased IL-2 in the brain (Mann et al, 2016).…”

“…Interestingly, many studies support the results that IL-2 is positively correlated with anxiety (Mann, Dail, & Bailey, 2016). The researchers supposed that emotional changes were associated with fluid overload or brain edema caused by increased IL-2 in the brain (Mann et al, 2016). However, IL-2 is not only a pro-inflammatory cytokine, but also an important cytokine of antitumor immunity in glioma (Rosenberg, Lotze, & Mulé, 1988).…”

The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review

“…It also promotes self-tolerance and inhibits the growth of some human tumor cells [79]. IL-2 is currently being used to treat auto-immune disorders and various cancers [84][85][86]. However, there are still unanswered questions about whether this increase has a clinically relevant impact on immunity, whether a similar increase can be seen in people with various pathological conditions, how long this effect lasts, and whether it has a positive impact in patients with autoimmune conditions, or cancer patients, or whether it has an anti-inflammatory effect.…”