ABSTRACT

Introduction: Significant advances in neuro-oncological treatment led to considering neurocognitive functioning and everyday functional needs in patients with long-term survival. Since a potentially lethal disease interrupts normal life and represents a threat to physical and psychological integrity, patients have to cope with the new challenges. Long-term survival and even “cure” is possible in primary central nervous system lymphoma (PCNSL), however, suffering from a life-threatening disease may affect patients´ cognitive processing of past and future (i.e., the generation of personal past memories and generation of personal future events). Therefore, the present study aimed to assess how PCNSL long-term survivors remember their past and anticipate their future.

Methods: Recall of past and anticipation of future events (i.e., mental time travel), both positive and negative, was assessed in 39 PCNSL patients with ongoing complete remission to therapy for at least 1 year in an adapted verbal fluency paradigm. A group of 39 healthy controls matched for age, gender and education was assessed with the same paradigm evaluating retrospective and prospective cognitions.

Results: Concerning the generation of personal future events PCNSL patients anticipated significantly fewer negative events for the distant future as compared to healthy controls. At trend level, patients also reported fewer negative events regarding their recent past.

Conclusions: The results provide support for an altered generation of personal future events (i.e., future-directed assumptions) in PCNSL patients with ongoing complete remission. Being “cured” after experiencing a threat to life might induce cognitive reappraisal processes and lead people to reexamine their priorities and principles in life, resulting in a less negative evaluation of (future) life (i.e., “optimism bias”) after facing death. Clinicians should be aware of these possible cognitive and affective processes and of chronic psychological disturbances in cancer survivors. Possible adaptive strategies ought to be promoted in supportive (neuro)psychological therapy.

摘要

简介：神经肿瘤治疗的重大进展导致考虑长期存活患者的神经认知功能和日常功能需求。由于潜在的致命疾病会中断正常生活并对身心健康构成威胁，因此患者必须应对新的挑战。原发性中枢神经系统淋巴瘤 (PCNSL) 有可能长期存活甚至“治愈”，然而，患上危及生命的疾病可能会影响患者对过去和未来的认知处理（即个人过去记忆的产生和个人未来事件的产生）。因此，本研究旨在评估 PCNSL 长期幸存者如何记住他们的过去并预测他们的未来。

方法：对 39 名持续完全缓解治疗至少 1 年的 PCNSL 患者以适应的语言流畅范式评估过去事件的回忆和未来事件（即心理时间旅行）的预期（即心理时间旅行），包括积极的和消极的。对年龄、性别和教育相匹配的 39 名健康对照者使用相同的范式进行评估，以评估回顾性和前瞻性认知。

结果：关于个人未来事件的产生，与健康对照相比，PCNSL 患者对遥远未来的负面事件预期显着减少。在趋势水平上，患者报告的关于他们最近过去的负面事件也较少。

结论：结果为持续完全缓解的 PCNSL 患者个人未来事件（即，未来导向的假设）的改变提供了支持。在经历生命威胁后被“治愈”可能会引发认知重新评估过程，并导致人们重新审视他们在生活中的优先事项和原则，从而减少面对死亡后对（未来）生活的负面评价（即“乐观偏见”）。临床医生应该意识到这些可能的认知和情感过程以及癌症幸存者的慢性心理障碍。应该在支持性（神经）心理治疗中推广可能的适应性策略。