Effects Of Different Doses Of Vitamin D On Cancer-Related Cognitive Impairment In Patients With Gastrointestinal Malignancies

Objectives:1.To clarify the reliability,validity and optimal threshold of the Chinese version of the Functional Assessment of Cancer Therapy-Cognitive Function Scale(FACT-Cog).2.To clarify the occurrence status and influencing factors of cancer-related cognitive impairment in patients with gastrointestinal malignancy.3.To evaluate the effects of different doses of vitamin D on postoperative cognitive function in patients with gastrointestinal malignancies.Methods:1.The reliability,validity and optimal threshold of the Chinese version of the Functional Assessment of Cancer Therapy-Cognitive Function Scale(FACT-Cog).Random sampling method was used to conduct a questionnaire survey on gastrointestinal malignancy patients who planned to undergo radical gastroenterectomy by using self-prepared general data questionnaire and Chinese version of Functional Assessment of Cancer TherapyCognitive Function Scale.The Montreal Cognitive Assessment Scale was used as the criterion of the patient functional assessment-Cognitive function scale to detect its correlation.The scale validity was evaluated by structural validity,convergence validity,discriminative validity and criterion association validity.Cronbach’s α coefficient,split half reliability and retest reliability were used to evaluate reliability.Receiver operating characteristic curve(ROC),Area Under Curve(AUC),Youden’s index,Receiver operating characteristic curve(ROC),sensitivity,specificity and Youden’s index(YI)to determine the optimal threshold of the Chinese version of the Functional Assessment of Cancer Patients-Cognitive Function Scale.2.The occurrence and influencing factors of cancer-related cognitive impairment in patients with gastrointestinal malignancy.Random sampling method was used.The self-compiled general data questionnaire,the Chinese version of the Functional Assessment and Cognitive Function Scale for Cancer patients,the Auditory word Learning Test Huashan Edition,the connection test,the number symbol conversion test,the similarity test,the clock drawing test,and the comprehensive assessment scale with frailty,fatigue,sleep,ability of daily living,and the risk of venous thromboembolism were used to conduct the preoperative questionnaire survey.Relevant hematological indicators were recorded.Independent sample t test,variance analysis,Chisquare test,Mann-Whitney U rank sum test,univariate analysis and binary Logistic regression analysis were used for statistical analysis.3.The effects of different doses of vitamin D on postoperative cognitive function in patients with gastrointestinal malignancies.A total of 114 patients with gastrointestinal malignancies undergoing radical gastroenterectomy were randomly divided into high-dose group,low-dose group and control group by randomized control method.The two intervention groups were supplemented with 400IU/day vitamin D3 supplement and 2000IU/day vitamin D3 supplement on the second day after surgery,while the control group did not receive any intervention.All patients were evaluated for cognitive function on the first day before surgery and the tenth day after surgery.General information of patients in each group was recorded.Cognitive function scores and comprehensive assessment scores were performed before surgery and on the tenth day after surgery.The levels of urea(UA),cy statin(Cys-C),C-reactive protein(CRP),D-dimer,IL-1β,IL-2,IL-6,tumor necrosis factor(TNF-α)and 25 hydroxyvitamin D(25(OH)D)were observed before and 10 days after surgery.After normal distribution test and Levene’s homogeneity of variance test,the differences in cognitive function,comprehensive evaluation,and hematological indicators between the three groups before and after surgery were statistically analyzed using analysis of variance and Kruskal Wallis H test.The differences in cognitive function,comprehensive evaluation,and hematological indicators between each group before and after surgery were statistically analyzed using paired sample t test and Friedman M test.Analysis of variance and Kruskal Wallis H test were used to statistically analyze the differences in cognitive function between each group before and after surgery.Dunnett-t test,Tukey test,Tambane’s T2 test,and Games-Howell test were used to compare and analyze the differences.According to the results of the homogeneity test of variance,Dunnett-t test,Tukey test,Tambane’s T2 test,and Games-Howell test were used to compare the differences between two groups.Results:1.The reliability,validity and optimal threshold of the Chinese version of the Functional Assessment of Cancer Therapy-Cognitive Function Scale.A total of 200 patients with gastrointestinal malignant tumor were included in the reliability and validity test,with Cronbach’s a coefficient of 0.876.Cronbach’s α coefficients of 4 dimensions(perceived cognitive dysfunction,other people’s comments,perceived cognitive ability,impact on quality of life)were 0.985 1,0.946,0.838 and 0.969,respectively.Retest reliability of the scale was 0.975.KMO value was 0.918 and Bartlett’s spherical test value was 4532.209.The chi-square degree of freedom ratio(χ2/df)=2.103,the Goodness of Fit Index(GFI)=0.859,Root Mean Square Error of asymptotically residual(RMSEA)=0.060;AVE>0.36,CR>0.7;The AUC under ROC curve was 0.942(P<0.001)and 95%CI was 0.916～0.969.The reliability and validity of the scale are good.The sensitivity was 84.6%,the specificity was 90.7%,the maximum entry index was 0.753.The best cut-off value after integer value is 75 points.2.The occurrence and influencing factors of cancer-related cognitive impairment in patients with gastrointestinal malignancy.A total of 200 patients with gastrointestinal malignancies were included in the crosssectional study,among which 134 patients developed cancer-related cognitive impairment,with an incidence of 67.0%.Univariate analysis showed that there were significant differences in cognitive function in age,education level,place of residence,diabetes history,sleep and frailty(P<0.05).Binary Logistic regression analysis showed that advanced age(OR=2.163,95%CI(1.092,4.282))and frailty(OR=2.468,95%CI(1.186,5.134))were risk factors for developing cancer-related cognitive impairment in gastrointestinal malignancies.3.The effects of different doses of vitamin D on postoperative cognitive function in patients with gastrointestinal malignancies.The results of intervention study showed that the three groups of patients’ general information,preoperative cognitive function score and preoperative hematology indicators,the comparison between preoperative group cancer-related fatigue,CRP,IL1-β,IL-6 and TNFβ differences statistically significant(P<0.05);Contrast between postoperative day 10 group AVLT-H,sleep,cancer because of fatigue,weakness,IL-2,IL-6,TNF-α and 25(OH)D statistically significant difference(P<0.05);Before and after comparison within the group showed that there were statistically significant differences among the three groups(P<0.05).The differences of FACT-Cog,AVLT-H,ST,MTT-B,DSST,CDT,CRP,IL-6,TNF-α,25(OH)D,frailty and self-care ability were statistically significant(P<0.05).The difference was compared in pairs and it was found that the difference of FACT-Cog,AVLT-H,ST,MTT-B,DSST,CDT,CRP,TNF-α,frailty and self-care ability among different groups were statistically significant(P<0.05).Cancer-related cognitive dysfunction occurred in 7 patients in the highdose intervention group(18.42%),8 patients in the low-dose intervention group(21.05%),and 7 patients in the control group(18.42%),and the incidence was different among the three groups,but the difference was not statistically significant(P>0.05).Conclusion:1.The Chinese version of the Functional Assessment of Cancer Therapy-Cognitive Function Scale has good reliability and validity in patients with gastrointestinal malignancy,and the recommended best cut-off value is 75 points,which can be used to evaluate the cognitive function of patients with gastrointestinal malignancy.2.Advanced gastrointestinal malignancy leads to a high incidence of cancer-related cognitive impairment.Advanced age and combined fragility are risk factors for the occurrence of cancerrelated cognitive impairment.Clinical nursing staff pay attention to the cognitive function of elderly patients with gastrointestinal malignancy and pay attention to the prevention and nursing of fragility in daily nursing,so as to reduce the occurrence of cancer-related cognitive impairment in patients with gastrointestinal malignancy.3.Vitamin D can improve the cognitive function of patients with gastrointestinal malignancies to a certain extent,as well as cognitive memory,language ability,executive power,concentration,and visual spatial structure ability,thus reducing the incidence of cancer-related cognitive dysfunction,reducing the occurrence of postoperative complications,and effectively shortening the length of hospital stay.Moreover,high dose intake is superior to low dose intake,which is worthy of application in practical clinical nursing.