Neuropsychology and Brain Cancer

Transcript

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00:17 --> 00:19Welcome to Yale Cancer Answers with
00:19 --> 00:21your host Doctor Anees Chagpar.
00:21 --> 00:23Yale Cancer Answers features the
00:23 --> 00:25latest information on cancer care
00:25 --> 00:27by welcoming oncologists and
00:27 --> 00:29specialists who are on the
00:29 --> 00:31forefront of the battle to fight
00:31 --> 00:32cancer. This week it's a
00:32 --> 00:33conversation about neuropsychology
00:33 --> 00:35and brain cancer with doctor
00:35 --> 00:37Franklin Brown. Doctor Brown is an
00:37 --> 00:39assistant professor of neurology
00:39 --> 00:41and chief of the division of
00:41 --> 00:43neuropsychology at the Yale School
00:43 --> 00:45of Medicine where Doctor Chagpar
00:45 --> 00:47is a professor of surgical
00:47 --> 00:49oncology.
00:49 --> 00:52Dr. Brown, maybe we can start
00:52 --> 00:55off by you telling us a little bit
00:55 --> 00:57about what exactly is neuropsychology,
00:57 --> 00:59and how does that
00:59 --> 01:02interface with the world of cancer?
01:02 --> 01:04Neuropsychology is really
01:04 --> 01:06the study of cognition.
01:06 --> 01:07Things like memory,
01:07 --> 01:09attention span, language skills,
01:09 --> 01:11visual spatial skills,
01:11 --> 01:13all these different things that
01:13 --> 01:16your brain does on a daily basis to
01:16 --> 01:19basically think and talk and interact.
01:19 --> 01:22So that's basically what the field
01:22 --> 01:24looks at within brain tumors.
01:24 --> 01:26It's important because it helps assess
01:26 --> 01:29the impact of brain tumors on cognition,
01:29 --> 01:32but we can also use it to predict
01:32 --> 01:35in some cases what might happen
01:35 --> 01:38if the tumor is removed,
01:38 --> 01:40and it also might help guide
01:40 --> 01:43various methods of removal in
01:43 --> 01:45some cases so it can help guide
01:45 --> 01:48the impact of the tumor removal,
01:48 --> 01:50but also help the patient
01:50 --> 01:52and health care providers understand
01:52 --> 01:54the impact after it happens
01:54 --> 01:56and also help guide therapies.
01:56 --> 01:59And I can imagine that if somebody is
01:59 --> 02:00diagnosed with a brain tumor,
02:00 --> 02:02I mean just the concept and
02:02 --> 02:05the words itself makes you think, Oh my gosh,
02:05 --> 02:07what's going to happen?
02:08 --> 02:11Am I going to be able to think,
02:11 --> 02:13am I going to lose my IQ?
02:13 --> 02:16Am I going to be able to speak?
02:18 --> 02:21I'd imagine that there are a lot of
02:21 --> 02:24factors that go into that in terms of
02:24 --> 02:27where in the brain is this tumor and
02:27 --> 02:31what part of the brain does it affect?
02:31 --> 02:33Tell us a little bit more about
02:33 --> 02:36how you do that and how you
02:36 --> 02:38help patients and clinicians
02:38 --> 02:41get a sense of what this brain
02:41 --> 02:43tumor is doing and what
02:43 --> 02:46the ramifications of treatment are.
02:46 --> 02:48As you can imagine,
02:48 --> 02:50there all kinds of brain
02:50 --> 02:53tumors and they are discovered in
02:53 --> 02:54different ways. One way that
02:54 --> 02:58my field tends to interact a lot with brain
02:58 --> 02:59tumors can be from seizures.
02:59 --> 03:01In epilepsy there are some patients that
03:01 --> 03:03will randomly start developing seizures,
03:03 --> 03:06and as part of the work up they might
03:06 --> 03:09find the tumor and in some cases it
03:09 --> 03:11might be a very slow growing tumor,
03:11 --> 03:14in which case they might watch it for awhile
03:14 --> 03:17and they may not do anything with it,
03:17 --> 03:19because it might discover that it's been there
03:19 --> 03:21for the patients whole life for
03:21 --> 03:22most of their life,
03:22 --> 03:24and sometimes the resection or the
03:24 --> 03:26taking of the tumor might actually
03:26 --> 03:30put them at risk, so the slow growing to
03:30 --> 03:33more or less stable tumor like that,
03:34 --> 03:36it's much more of a thoughtful process
03:36 --> 03:39and I would evaluate them and then we would
03:39 --> 03:41test to see OK,
03:41 --> 03:44what are there risks in this case?
03:44 --> 03:46And so in that kind of tumor it's
03:46 --> 03:48I'm sure it's scary for that patient.
03:48 --> 03:51Have a tumor, but I think in those cases
03:51 --> 03:53that doctors are pretty clear of, well,
03:53 --> 03:55this might have been their whole life.
03:55 --> 03:57We don't know if it's growing,
03:57 --> 04:00we can kind of look at this and take
04:00 --> 04:03our time and figure out the next step.
04:03 --> 04:06So in that kind of situation I don't.
04:06 --> 04:07I mean, I'm not.
04:07 --> 04:09I've not had that happen to me,
04:09 --> 04:12but I don't imagine it sounds quite as
04:12 --> 04:15urgent as in cases where there is a
04:15 --> 04:17tumor that appears to have grown abruptly,
04:17 --> 04:20and that can be quite scary for the patients,
04:20 --> 04:23and so in those cases there's not
04:23 --> 04:26the time for me to kind of do a
04:26 --> 04:28presurgical work up and help them
04:28 --> 04:30figure out the next step.
04:30 --> 04:32In those cases where the tumors fast moving,
04:32 --> 04:35I'm sure it's much scarier for people.
04:35 --> 04:38Because it's so fast and many times I
04:38 --> 04:41cannot help at that point it's you know.
04:41 --> 04:42Like for example, this,
04:42 --> 04:45the surgeon might have to go in
04:45 --> 04:46and operate right away,
04:46 --> 04:49and so there's not even any time for the
04:49 --> 04:52patient to process what's about to happen,
04:52 --> 04:54let alone have them see me to
04:54 --> 04:56predict what's going to happen.
04:56 --> 04:59So in those cases, it's much more of a.
04:59 --> 05:00I'm following up,
05:00 --> 05:03and I'm seeing how they're doing afterwards,
05:03 --> 05:05but as you can imagine.
05:05 --> 05:07If it's a fast moving tumor,
05:07 --> 05:09the patient just wants to know
05:09 --> 05:11that they're going to live there.
05:11 --> 05:12Not worried about what I do.
05:12 --> 05:15In most cases, they just want to be OK,
05:15 --> 05:17'cause you know the brain tumor.
05:17 --> 05:20It's gotta be a scary thing to hear a doctor,
05:20 --> 05:21say to you.
05:21 --> 05:23You know, I can't imagine how,
05:23 --> 05:24how fearful that is.
05:24 --> 05:25But like I said,
05:25 --> 05:26there's different types and
05:26 --> 05:27more slow growing ones.
05:27 --> 05:29I'm sure the doctors can describe
05:29 --> 05:31those in a com away,
05:31 --> 05:32then when it's OK,
05:32 --> 05:34it's a tumor we have to
05:34 --> 05:36go and operate tomorrow. I can't
05:36 --> 05:37imagine how scary that would sound.
05:38 --> 05:41Yeah, and I would imagine that you know,
05:41 --> 05:43there's certainly a balance between
05:43 --> 05:46the symptoms that the brain tumor
05:46 --> 05:49is causing by being in your brain.
05:49 --> 05:52So for example, the seizures that you have
05:52 --> 05:55that maybe there on a daily or weekly
05:55 --> 05:57basis versus the potential disabilities
05:57 --> 06:00that you may have with resection.
06:00 --> 06:03How do you kind of balance that in
06:03 --> 06:06patients who might be thinking about,
06:06 --> 06:09you know, do I undergo a treatment,
06:09 --> 06:12whether it's surgery or radiation?
06:12 --> 06:15Versus do I live with this tumor if if
06:15 --> 06:17they're kind of facing that dichotomy,
06:17 --> 06:20how do you kind of counsel them?
06:20 --> 06:21So if
06:21 --> 06:24it's if it's a creditor that you describe,
06:24 --> 06:27which is usually the type that's not.
06:27 --> 06:28That did not going to die
06:28 --> 06:30immediately if it's not taken out.
06:30 --> 06:31There are of course case
06:31 --> 06:33where there's whether it so,
06:33 --> 06:35like if you don't take this out,
06:35 --> 06:37that's going to be it. You know,
06:37 --> 06:38I'm sure that those are the squirrels,
06:39 --> 06:41but the kind that you were talking about
06:41 --> 06:43are the ones that we actually have time to.
06:43 --> 06:45Maybe evaluate them before surgery and the
06:45 --> 06:47way that the test student works is well,
06:47 --> 06:49so will test different things.
06:49 --> 06:49Like I said,
06:49 --> 06:51the language in different kinds of memory,
06:51 --> 06:53and if it turns out that that part
06:53 --> 06:55of the brain with the tumors in
06:55 --> 06:57is not working properly anyways.
06:57 --> 06:59Like let's say the tumors in the
06:59 --> 07:01part of the brain that's important
07:01 --> 07:03for verbal memory and verbal memory
07:03 --> 07:06is terribly impaired at that point.
07:06 --> 07:08But that point we could say to them,
07:08 --> 07:10while you know there's very little
07:10 --> 07:11risk because you're already having
07:11 --> 07:12a lot of problems here,
07:12 --> 07:14and it's unlikely to get much worse,
07:14 --> 07:17and it might actually get better.
07:17 --> 07:18In that conversation,
07:18 --> 07:20the patient can take oh OK,
07:20 --> 07:20well,
07:20 --> 07:23so this is just causing problems and if he
07:23 --> 07:27takes it out of something to get much worse.
07:27 --> 07:27In other cases,
07:27 --> 07:28if the paint,
07:28 --> 07:30let's say a patient,
07:30 --> 07:31is very high functioning and
07:31 --> 07:33they have no problems and their
07:33 --> 07:35memories all their memory is great
07:35 --> 07:38and the tumors in a spot that if
07:38 --> 07:40they take it out it might impact
07:40 --> 07:41some important cognitive function.
07:41 --> 07:42You know,
07:42 --> 07:43let's say the persons a physician
07:43 --> 07:46or a physicist or chemist or an
07:46 --> 07:48engineer or or just anybody who's
07:48 --> 07:50brain is doing just fine is now told
07:50 --> 07:53that we the doctor may want to cut
07:53 --> 07:56out or take out part of their brain.
07:56 --> 07:57Naturally,
07:57 --> 07:59if there's if there's no pre existing
07:59 --> 08:01impairment from the tumor itself,
08:01 --> 08:03then you've gotta start asking.
08:03 --> 08:04Is this worth it?
08:04 --> 08:06And I think that in many cases
08:06 --> 08:09that depends on what's going on
08:09 --> 08:10with the neurosurgeon.
08:10 --> 08:11By say,
08:11 --> 08:13let's wait and watch and see
08:13 --> 08:15if it even grows.
08:15 --> 08:16There might be other alternatives.
08:16 --> 08:17For example,
08:17 --> 08:19maybe they'll try chemotherapy
08:19 --> 08:21or focused radiation therapy.
08:21 --> 08:22You know,
08:22 --> 08:24that's where it really gets in
08:24 --> 08:26the thick of what we want to do,
08:26 --> 08:28but I think that's really the next,
08:28 --> 08:28you know,
08:28 --> 08:29there's excellent conditions
08:29 --> 08:31in various places in it.
08:31 --> 08:31Yeah,
08:31 --> 08:34we have some very good ones that are very
08:34 --> 08:36good at detecting what can be taken out,
08:36 --> 08:38so they might take out part
08:38 --> 08:40of it but leave in part,
08:40 --> 08:41which sounds scary.
08:41 --> 08:42But it might be that if
08:42 --> 08:44they leave in that part,
08:44 --> 08:46there's a low risk for recurrence.
08:46 --> 08:48So there's many factors taken into account.
08:48 --> 08:49And believe me,
08:49 --> 08:50when the neurosurgeon has that
08:50 --> 08:51meeting with the patients.
08:51 --> 08:54They have looked at all different
08:54 --> 08:56options and I have to say
08:56 --> 08:58that the ones that I work with
08:58 --> 09:00their very thoughtful and very
09:00 --> 09:02much do not just say OK,
09:02 --> 09:03let's take it out.
09:03 --> 09:05Unless of course it's vital
09:05 --> 09:07for their life, you know.
09:07 --> 09:09So it does depend the type.
09:09 --> 09:11But Yes, there's many ways
09:11 --> 09:13that we could be careful to
09:13 --> 09:14reduce the risk after surgery.
09:14 --> 09:17So how exactly does that happen?
09:17 --> 09:19I mean, when we think about,
09:19 --> 09:20you know the neurosurgeon
09:20 --> 09:22going in there to take out.
09:22 --> 09:25Part of the brain where the tumor is.
09:25 --> 09:28But you know making sure that they
09:28 --> 09:31don't damage other parts of the brain,
09:31 --> 09:34that the tumor might be next to that.
09:34 --> 09:37If they they do take out or or damage
09:37 --> 09:40that area that the patient could be
09:40 --> 09:43left with severe deformities in terms
09:43 --> 09:46of you know their memory or their
09:46 --> 09:50cognition or their language skills.
09:50 --> 09:52Can the surgeons actually see which areas
09:52 --> 09:56which or do they need fancy image Ng?
09:56 --> 10:00Or is there a way that that's done with?
10:00 --> 10:02You know, while patients are awake,
10:02 --> 10:04I know that we've all seen kind
10:04 --> 10:06of shows on people taking care
10:06 --> 10:08of seizures with patients awake.
10:08 --> 10:10How does that happen for patients
10:10 --> 10:11with cancer?
10:11 --> 10:12So this is
10:12 --> 10:14a great question, and there's a
10:14 --> 10:17lot of tools that are now used
10:17 --> 10:19before the surgeon even goes in.
10:19 --> 10:21They have all these kinds of data.
10:21 --> 10:22I have time.
10:22 --> 10:24They've done different kinds of Mris.
10:24 --> 10:27There's a kind of MRI called
10:27 --> 10:28diffusion tensor imaging,
10:28 --> 10:29which actually tracks the
10:29 --> 10:31pathways in the brain because.
10:31 --> 10:33What are the biggest risks with
10:33 --> 10:35surgery is if they if they hit a
10:35 --> 10:36pathway they might not hit this
10:36 --> 10:38Center for some kinds of ticket.
10:38 --> 10:40But if you hit the wrong path
10:40 --> 10:41way you know could cause
10:41 --> 10:42some pretty global problems.
10:42 --> 10:44So with all the image Ng
10:44 --> 10:45data that's available today,
10:45 --> 10:47there are many ways that before
10:47 --> 10:49they even go in they already have
10:49 --> 10:51an idea of what they're going to
10:51 --> 10:52say that I can't speak for them,
10:52 --> 10:54but in the in the T meetings that
10:54 --> 10:56have been part of pretty much they
10:56 --> 10:58have an eye discharge and has a very
10:58 --> 11:00good idea exactly what they're going
11:00 --> 11:03to take out before they ever go in.
11:03 --> 11:04Now, sometimes once they're in,
11:04 --> 11:06they'll find the tumors more extensive
11:06 --> 11:08or has something more to problem,
11:08 --> 11:09but they were.
11:09 --> 11:11They are very careful.
11:11 --> 11:14You know, and that's that's really the key.
11:14 --> 11:15Now the other pieces.
11:15 --> 11:17Sometimes there is awake intra
11:17 --> 11:20operative map and it's called and
11:20 --> 11:22that means the patients actually
11:22 --> 11:24kept awake and some like myself
11:24 --> 11:26or other providers or even the
11:26 --> 11:28surgeon will talk to the patient
11:28 --> 11:31while doing the surgery to kind of
11:31 --> 11:33predict what's going to happen.
11:33 --> 11:34And there might.
11:34 --> 11:36They might even use a little
11:36 --> 11:38stimulation to kind of determine OK,
11:38 --> 11:41if we you know the stimulate the
11:41 --> 11:44area around the tumor to find out.
11:44 --> 11:46If they stimulate certain parts,
11:46 --> 11:47is it stopped language?
11:47 --> 11:48This language continue,
11:48 --> 11:50so sometimes during the actual
11:50 --> 11:52procedure the patient will be awake
11:52 --> 11:54and areas are under tomorrow be
11:54 --> 11:56stimulated to find out what would impact.
11:56 --> 11:59The impact would be if that
11:59 --> 12:00part was taken out.
12:00 --> 12:02So it's really quite amazing what
12:02 --> 12:04what they do in the neurosurgery
12:04 --> 12:06suite during these cases.
12:06 --> 12:08And now there's all kinds of newer tools.
12:08 --> 12:10There's a laser ablation therapy
12:10 --> 12:13where they'll take a laser and it's
12:13 --> 12:15like a same day procedure where they.
12:15 --> 12:18The next day, their home.
12:18 --> 12:19Of course.
12:19 --> 12:20Is there radiation types,
12:20 --> 12:22but but there are a lot of
12:22 --> 12:24different ways now that the surgeon
12:24 --> 12:26has to really know exactly what
12:26 --> 12:28they're going to be further going,
12:28 --> 12:30and so we will work with them.
12:30 --> 12:31We will have them do what's
12:31 --> 12:33called a functional MRI,
12:33 --> 12:35which Maps were different language
12:35 --> 12:36and other cognitive functions
12:36 --> 12:38might be occurring will do our
12:38 --> 12:39testing to kind of find out.
12:39 --> 12:39OK,
12:39 --> 12:42that tumor is in this area that
12:42 --> 12:44braid it would affect this function.
12:44 --> 12:46But see how that functions working now.
12:46 --> 12:48Let's predict what's going
12:48 --> 12:49to happen afterwards,
12:49 --> 12:51so it's really by the time
12:51 --> 12:52they go into surgery.
12:52 --> 12:53Unless it's an emergency situation,
12:53 --> 12:55there is a lot of planning,
12:55 --> 12:58and they pretty much know.
12:58 --> 12:59With a fairly good,
12:59 --> 13:01certainly what's going to happen before
13:01 --> 13:02the surgery even occurs.
13:02 --> 13:03That way, the patient and their
13:03 --> 13:05family could be talked about.
13:05 --> 13:07OK, here's what to expect.
13:07 --> 13:08Now of course, every once awhile
13:08 --> 13:10there might be a surprise,
13:10 --> 13:12and that's always your risk.
13:12 --> 13:13But many times that we really
13:13 --> 13:15strive so they know what to expect
13:15 --> 13:17before it even happens.
13:17 --> 13:19Yeah, I mean, it really is cool how
13:19 --> 13:21far surgery and technology is come.
13:21 --> 13:23It's kind of. It's kind of weird to
13:23 --> 13:25think about having somebody take out
13:25 --> 13:27a brain tumor with you being awake.
13:27 --> 13:29But on the other hand, it really is
13:29 --> 13:31pretty cool that you know you can.
13:31 --> 13:33You can give the surgeon
13:33 --> 13:34real time feedback of,
13:34 --> 13:36you know if you go in that spot.
13:36 --> 13:38I'm going to stop talking,
13:38 --> 13:40and if you go in that spot.
13:40 --> 13:44I'm going to start shaking and and so on.
13:44 --> 13:47You mentioned things like Lazaran radiation.
13:47 --> 13:49Are those more or less toxic to
13:49 --> 13:52your brain in terms of causing side
13:52 --> 13:56effects in terms of a bleeding tumors?
13:56 --> 13:58I mean, are they better in
13:58 --> 14:00terms of reducing the cognitive
14:00 --> 14:03side effects of having your
14:03 --> 14:04cancer treated well?
14:04 --> 14:07I know more about laser ablation from
14:08 --> 14:10the epilepsy patients at that time.
14:10 --> 14:13Part of seeing and I know that in
14:13 --> 14:16the research, a good friend of mine,
14:16 --> 14:18there's a lot of these another institution,
14:18 --> 14:20and they've had a large data set
14:20 --> 14:22of patients and they find that
14:22 --> 14:24the laser ablation has very has at
14:24 --> 14:27least Kogda Side Effects afterwards,
14:27 --> 14:29and we've actually learned that the
14:29 --> 14:32laser ablation you could take out
14:32 --> 14:33parts that traditional surgery.
14:33 --> 14:36It would have damage to surrounding area,
14:36 --> 14:38but laser ablation might be able to
14:38 --> 14:41pinpoint a very precise location so
14:41 --> 14:44that actually has fewer cognitive risks.
14:44 --> 14:45And in terms of radiation,
14:45 --> 14:48you know there's more focused beam
14:48 --> 14:50radiation that they use now they
14:50 --> 14:52used to use whole brain radiation,
14:52 --> 14:55which was not good because that would
14:55 --> 14:58affect the whole brain as as a name implies,
14:58 --> 14:59it's a whole brain.
14:59 --> 15:02Radiation would impact the cognition
15:02 --> 15:03in a larger degree.
15:03 --> 15:05Whereas focused beam radiation
15:05 --> 15:06would affect that area.
15:06 --> 15:09Now the risk to radiation is that is
15:09 --> 15:12not just a time that's being used,
15:12 --> 15:14but there's also after effects,
15:14 --> 15:16so the radiation might continue
15:16 --> 15:18to affect the area of the brain.
15:18 --> 15:21So some of the cognition might actually
15:21 --> 15:23decline a little bit after the surgery,
15:23 --> 15:25after the radiation is even
15:25 --> 15:27over down the road,
15:27 --> 15:29you can have a little bit of
15:29 --> 15:31decline in that immediate area.
15:31 --> 15:32So yeah,
15:32 --> 15:32no sorry.
15:32 --> 15:34So this is. Really fascinating
15:34 --> 15:37in terms of how we can influence
15:37 --> 15:39our cognition while still
15:39 --> 15:42taking care of brain tumors.
15:42 --> 15:45We need to take a short break
15:45 --> 15:47for a medical minute,
15:47 --> 15:50but will learn more right after this
15:50 --> 15:53break with my guest. Doctor Franklin Brown.
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16:57 --> 16:57Welcome
16:57 --> 16:59back to Yale cancer answers.
16:59 --> 17:02This is doctor in East shag part
17:02 --> 17:04and I'm joined tonight by my guest
17:04 --> 17:06doctor Franklin Brown were talking
17:06 --> 17:08about neuropsychology and brain
17:08 --> 17:11cancer and right before the break.
17:11 --> 17:14Franklin we were talking a little bit
17:14 --> 17:16about surgery versus radiation which
17:16 --> 17:19can be focused or even lasers which can
17:19 --> 17:22be perhaps even more focused where you
17:22 --> 17:25know we can really address brain cancers
17:25 --> 17:27without affecting the entire brain.
17:27 --> 17:29Now the. The other modality,
17:29 --> 17:32of course that is sometimes used
17:32 --> 17:34is is chemotherapy and, you know,
17:34 --> 17:37chemotherapy can affect your brain to a
17:37 --> 17:40lot of people talk about chemo brain.
17:40 --> 17:43Can you talk a little bit about how
17:43 --> 17:46exactly does chemotherapy affect your brain?
17:46 --> 17:49I mean, it's certainly not a structural
17:49 --> 17:53thing of taking actual brain tissue out,
17:53 --> 17:55but it seems to still
17:55 --> 17:57affect people's cognition was sure,
17:57 --> 17:59and in fact, chemo.
17:59 --> 18:00Chemotherapy, while it's important,
18:00 --> 18:02can leave comments effects
18:02 --> 18:04regardless of the type of tumor.
18:04 --> 18:06Sowerby regards the type of cancer,
18:06 --> 18:08so we're talking about brain tumors,
18:08 --> 18:10but in any kind of cancer
18:10 --> 18:12that chemotherapy is used,
18:12 --> 18:14it can cross the blood brain barrier,
18:14 --> 18:17an effect the brain now.
18:17 --> 18:19The way this typically happens in the brain,
18:19 --> 18:21there's what's called the Gray matter,
18:21 --> 18:24which is where our actual thinking sells.
18:24 --> 18:27For like, a better term would be located.
18:27 --> 18:31But then this was called the white matter,
18:31 --> 18:34which connects to different parts of the
18:34 --> 18:36brain together and that white matter
18:36 --> 18:38is very important for functioning
18:38 --> 18:41but also for function efficiently.
18:41 --> 18:44So let's say that the chemotherapy because
18:44 --> 18:47it affects the person's general health.
18:47 --> 18:50This effects white matter.
18:50 --> 18:52More than Gray matter.
18:52 --> 18:52In fact,
18:52 --> 18:55it tested target white matter because white
18:55 --> 18:57matters affected by the body's health, so.
18:57 --> 19:00You have the white matter that gets
19:00 --> 19:03affected by chemotherapy and afterwards
19:03 --> 19:06patients have they feel foggy there.
19:06 --> 19:08Say they can't focus very well.
19:08 --> 19:10They're complaining memory problems,
19:10 --> 19:13and it really comes down to the brain
19:13 --> 19:15not communicating efficiently anymore.
19:15 --> 19:16And so it's.
19:16 --> 19:19There's different networks in the brain.
19:19 --> 19:21So let's say the actual.
19:21 --> 19:22Like I said,
19:22 --> 19:25the brain centers might be intact,
19:25 --> 19:27but the communication between
19:27 --> 19:29those centers are slowed down.
19:29 --> 19:30Therefore,
19:30 --> 19:31kits at a sink.
19:31 --> 19:33So imagine one way it imagine this
19:33 --> 19:35is like if you're very tired.
19:35 --> 19:38Let's say that you only got a few
19:38 --> 19:40hours sleep the night before and the
19:40 --> 19:43next day you're feeling kind of foggy.
19:43 --> 19:45You can't think as well.
19:45 --> 19:46You mind might wander,
19:46 --> 19:49you know all those things that you feel
19:49 --> 19:52when you're very tired and in a way,
19:52 --> 19:54this is kind of what chemotherapy
19:54 --> 19:56does the brain.
19:56 --> 19:58Because it makes it less efficient.
19:58 --> 20:00Your brain. It takes a lot more.
20:00 --> 20:01For to do things.
20:01 --> 20:03So this will result in the
20:03 --> 20:06person feeling tired, unfocused.
20:06 --> 20:08You know other factors that make
20:08 --> 20:10them less able to pay attention
20:10 --> 20:12to what's going on,
20:12 --> 20:14so cognitive efficiency is actually
20:14 --> 20:18is one of my areas of interest
20:18 --> 20:20is very vital for thinking.
20:20 --> 20:21Paid attention.
20:21 --> 20:24You know finding towards another
20:24 --> 20:26actions that are required
20:26 --> 20:28that chemotherapy affects so
20:28 --> 20:32you know, having thought about that right?
20:32 --> 20:34So especially when there is
20:34 --> 20:37some time to prepare, right?
20:37 --> 20:39So usually, regardless of whether
20:39 --> 20:42somebody is taking out a piece
20:42 --> 20:45of brain from brain tumor or
20:45 --> 20:47planning some focused radiation,
20:47 --> 20:50or whether you're going to be
20:50 --> 20:52getting some chemotherapy.
20:52 --> 20:54For brain cancer or any
20:54 --> 20:55other cancer for that matter,
20:55 --> 20:57oftentimes there's some preparatory
20:57 --> 20:58work that goes into that,
20:58 --> 21:00and we had talked before the break
21:00 --> 21:02about you know certainly in preparation
21:02 --> 21:04for brain surgery to remove tumors
21:04 --> 21:05that there's functional MRI's,
21:05 --> 21:07and so on and so forth.
21:07 --> 21:10So you have some time now I can
21:10 --> 21:12imagine that a lot of people who
21:12 --> 21:14might be listening to this show might
21:14 --> 21:16be asking themselves, you know,
21:16 --> 21:19is there something I can do?
21:19 --> 21:21In that period of time when I know
21:21 --> 21:24that my brain is going to be affected
21:24 --> 21:26by whatever treatment is to come,
21:26 --> 21:29is there something that I can do to help
21:29 --> 21:32myself preserve some of my cognition?
21:32 --> 21:34You know whether that is particularly a
21:34 --> 21:36particular diet that I should be eating,
21:36 --> 21:38or particular vitamins that
21:38 --> 21:39I should be taking,
21:39 --> 21:41or whether I should be doing
21:41 --> 21:43more crossword puzzles and trying
21:43 --> 21:45to keep my brain active?
21:45 --> 21:47Like what advice do you have,
21:47 --> 21:49or is there any advice?
21:49 --> 21:52For helping people to kind of
21:52 --> 21:54shore up their their brainpower,
21:54 --> 21:57their cognition to best withstand
21:57 --> 22:00the insult that is about to occur.
22:01 --> 22:03Well, one of the things that a lot of
22:03 --> 22:06people may not realize is that your
22:06 --> 22:08brain health things that make your
22:08 --> 22:10brain healthy are the same things
22:10 --> 22:12that make your heart healthy and in
22:12 --> 22:14fact was a big connection between
22:14 --> 22:16brain health and heart health.
22:16 --> 22:18In other words, if someones if
22:18 --> 22:20someone's cardiovascular system is is
22:20 --> 22:22at risk than their brain function,
22:22 --> 22:24it can be at risk,
22:24 --> 22:25which is a whole other topic,
22:26 --> 22:28but I think that one of the big things
22:28 --> 22:30is the healthier person is going
22:30 --> 22:32into a therapeutic situation like
22:32 --> 22:34chemotherapy or radiation or whatever.
22:34 --> 22:37The better the outcome generally,
22:37 --> 22:39so this means that if the person is
22:39 --> 22:42someone that exercises fairly regularly,
22:42 --> 22:45eats fairly healthy and you know
22:45 --> 22:47there's other things like that,
22:47 --> 22:50then they are going to be at
22:50 --> 22:53lower risk in general.
22:53 --> 22:55After surgery for cognitive problems
22:55 --> 22:58that people that let's say or less
22:58 --> 23:00healthy that might have some medical
23:00 --> 23:02risk factors like high blood pressure,
23:02 --> 23:03high cholesterol,
23:03 --> 23:05maybe they don't exercise really.
23:05 --> 23:07Maybe they are overweight,
23:07 --> 23:10you know there's all these things that
23:10 --> 23:12the more of these problems that occur,
23:12 --> 23:15the higher risk your brain is for.
23:15 --> 23:17For not being as healthy both
23:17 --> 23:20before and then after a surgery.
23:20 --> 23:22Sleep is also very important,
23:22 --> 23:24so following good sleep hygiene
23:24 --> 23:25recommendations is important,
23:25 --> 23:28but if you have someone that doesn't
23:28 --> 23:30exercise from that doesn't sleep well,
23:30 --> 23:32maybe they work long hours.
23:32 --> 23:34You know these are all things that
23:34 --> 23:36that when you think of Health,
23:36 --> 23:38the more or less healthy person
23:38 --> 23:41is a more cognitive risks they
23:41 --> 23:42have and vice versa.
23:42 --> 23:44So definitely that affects
23:44 --> 23:47the other thing is also mood.
23:47 --> 23:49You know it could be very upsetting to
23:49 --> 23:52find out someone has cancer and that
23:52 --> 23:54can affect the person pretty rapidly.
23:54 --> 23:56So the other thing is how do
23:56 --> 23:58you keep your mood up now?
23:58 --> 24:00Of course there are answer,
24:00 --> 24:02depresses and things like that.
24:02 --> 24:04But I'm actually a big a big believer
24:04 --> 24:07in therapy and so I really think that
24:07 --> 24:10when someone gets diagnosed with cancer.
24:10 --> 24:10To me,
24:10 --> 24:12I mean maybe I'm biased,
24:12 --> 24:14but from my perspective think if they
24:14 --> 24:17could all have access to accounts are.
24:17 --> 24:19Added time and after the diagnosis to
24:19 --> 24:22help them reframe their way of thinking,
24:22 --> 24:23deal with their anxiety.
24:23 --> 24:25So they can decrease depression
24:25 --> 24:28and anxiety going into it.
24:28 --> 24:30They're going to be better off
24:30 --> 24:32shape when they come out of it.
24:32 --> 24:35So things like that are very important.
24:35 --> 24:38An I mentioned sleep briefly.
24:38 --> 24:40There is growing evidence that sleep
24:40 --> 24:43definitely affects the brain functioning.
24:43 --> 24:44Whether it's long term,
24:44 --> 24:45for example sleep,
24:45 --> 24:47chronic seat problems are associated with
24:47 --> 24:50a higher risk of Alzheimer's disease,
24:50 --> 24:52or whether it's short term.
24:52 --> 24:54Adjust the immediate effects of fatigue.
24:54 --> 24:54Obviously,
24:54 --> 24:56if someone's having chronic sleep problems,
24:57 --> 24:59they're going to be more fatigue
24:59 --> 25:01and had more difficulty focusing.
25:01 --> 25:03Those things are also really important
25:03 --> 25:05for recovery from any kind of whether
25:05 --> 25:07it's a direct brain resection,
25:07 --> 25:08radiation therapy,
25:08 --> 25:09or chemotherapy.
25:09 --> 25:12So those are the things that.
25:12 --> 25:13I think in the idea world,
25:13 --> 25:15if we could really help the
25:15 --> 25:17patients go into it healthy.
25:17 --> 25:20Focus on it in a healthy way.
25:20 --> 25:22Help help deal with feelings
25:22 --> 25:23of depression, anxiety.
25:23 --> 25:25They're going to come out
25:25 --> 25:27with it out of it much better.
25:27 --> 25:30So it definitely there are ways
25:30 --> 25:32that that you can improve a
25:32 --> 25:34person's outcome in their risks.
25:34 --> 25:36Yeah, you know, all of that makes
25:36 --> 25:39me think about stress as well.
25:39 --> 25:41And you know, the the kind of
25:41 --> 25:43correlations between stress and
25:43 --> 25:45inflammation and an cancer in general,
25:45 --> 25:48but it sounds like kind of
25:48 --> 25:49regulating your stress might
25:49 --> 25:51might be helpful in terms of.
25:51 --> 25:53Preserving your brain function
25:53 --> 25:56as well are are there data on
25:56 --> 25:58that and an any particular things
25:58 --> 26:00in terms of stress reduction,
26:00 --> 26:02whether it be meditation or you
26:02 --> 26:03certainly mentioned exercise.
26:04 --> 26:06Right, so absolutely stresses
26:06 --> 26:10deftly can be toxic to the brain.
26:10 --> 26:12That there's been in decades past.
26:12 --> 26:14There's a lot of research and stress
26:14 --> 26:17and anxiety in the brain and there it
26:17 --> 26:19actually stress levels can actually impact
26:19 --> 26:22the size and volume of a memory center
26:22 --> 26:24of the brain called the hippocampus.
26:24 --> 26:26There were states that they did in the
26:26 --> 26:2880s and 90s where they actually found
26:28 --> 26:31that people with higher levels of stress
26:31 --> 26:33will have smaller memory centers like that.
26:33 --> 26:35The campus and then after they
26:35 --> 26:37get treated for that stress,
26:37 --> 26:38the MRI actually shows some
26:38 --> 26:39rebounding of the size,
26:39 --> 26:42which is unbelievable but is amazing so.
26:42 --> 26:44Absolutely, you know, stress is such
26:44 --> 26:47an important thing to help cope with,
26:47 --> 26:50and I think that you know
26:50 --> 26:51when someone's here.
26:51 --> 26:53We get diagnosed with cancer.
26:53 --> 26:57There focused might just be an OK I want to.
26:57 --> 26:59I want to survive.
26:59 --> 27:01I want to be healthy,
27:01 --> 27:04but the way they survive in the
27:04 --> 27:07way they feel is absolutely vital.
27:07 --> 27:09So things like obviously just
27:09 --> 27:11you know talking therapist really
27:11 --> 27:13helpful thing mindfulness meditation.
27:13 --> 27:15Some people also do well with
27:15 --> 27:16what's called cognitive imagery,
27:16 --> 27:19where they are asked to imagine the
27:19 --> 27:22situation so they calm down and imagine
27:22 --> 27:24it working out at a certain way.
27:24 --> 27:26There's been studies in various areas
27:26 --> 27:28that find that guided imagery where
27:28 --> 27:31person imagines their outcome seems to
27:31 --> 27:33produce a sense of better self control
27:33 --> 27:35and had better locus of control,
27:35 --> 27:37which seems to help their outcomes.
27:37 --> 27:38You know,
27:38 --> 27:40so definitely the level of stress
27:40 --> 27:41is very important,
27:41 --> 27:43and the more we can treat that
27:43 --> 27:45and reduce the level of stress
27:45 --> 27:47before and after surgery,
27:47 --> 27:48the better the outcome.
27:48 --> 27:52And of course it better the quality of life.
27:52 --> 27:52You know.
27:52 --> 27:54If someone is feeling depressed and
27:54 --> 27:57they feel like they're hopeless.
27:57 --> 27:58And they feel like there's no
27:58 --> 28:00way out and they look at their
28:00 --> 28:02health and they just can't imagine
28:02 --> 28:04that it's going to workout.
28:04 --> 28:06They're not going to do well,
28:06 --> 28:07no matter what an versus someone
28:07 --> 28:09that has an optimistic viewpoint.
28:09 --> 28:12It says, OK, well, this is not a big deal.
28:12 --> 28:14The doctor said that this could work,
28:14 --> 28:16and I know it's going to work fine,
28:16 --> 28:18and they imagine it's going to work.
28:18 --> 28:19It's really remarkable.
28:19 --> 28:20The difference in outcomes
28:20 --> 28:23then, and that's where I think
28:23 --> 28:24that that talk therapy can
28:24 --> 28:26really help. But you mentioned.
28:26 --> 28:30Yes, so there's a kind of typical
28:30 --> 28:31cognitive behavioral therapy. An.
28:31 --> 28:33That's when people that with the
28:33 --> 28:35provider works would help the
28:35 --> 28:37person to reframe their thinking.
28:37 --> 28:39So maybe they could take
28:39 --> 28:40something and instead thinking
28:40 --> 28:42negative negatively about it,
28:42 --> 28:44think more positively and effects
28:44 --> 28:46to give you an example of a
28:46 --> 28:48different area in multiple sclerosis
28:48 --> 28:50which also affects white matter.
28:50 --> 28:51And I mention chemotherapy
28:51 --> 28:52effects white matter.
28:52 --> 28:54There's actually evidence that people
28:54 --> 28:57that have multiple sclerosis who go
28:57 --> 28:58through constant behavioral therapy
28:58 --> 29:01have fewer relapses in there and
29:01 --> 29:02their white matter looks better.
29:02 --> 29:05So there is definitely evidence
29:05 --> 29:07that talk therapy, guided imagery,
29:07 --> 29:09relaxation, meditation, sleeping well,
29:09 --> 29:11eating well and healthy exercise
29:11 --> 29:13are very helpful.
29:13 --> 29:16And cancer is actually some empirical data.
29:16 --> 29:18That exercise helps recovery cognitive
29:18 --> 29:21remediation which is like like
29:21 --> 29:23things like speech therapy or or
29:23 --> 29:25focused therapy to help someone's
29:25 --> 29:28memory or compensation strategies.
29:28 --> 29:30All these things have been found
29:30 --> 29:33empirically to help the outcomes.
29:33 --> 29:35Of people that go through chemotherapy,
29:35 --> 29:37but definitely stress, I think,
29:37 --> 29:39is definitely underlying factor
29:39 --> 29:41in all these interventions.
29:41 --> 29:43Doctor Franklin Brown is an assistant
29:43 --> 29:46professor of neurology and chief
29:46 --> 29:48of the division of neuropsychology
29:48 --> 29:50at the Yale School of Medicine.
29:50 --> 29:52If you have questions,
29:52 --> 29:53the address is canceranswers@yale.edu
29:53 --> 29:56and past editions of the program
29:56 --> 29:58are available in audio and written
29:58 --> 30:00form at Yalecancercenter.org.
30:00 --> 30:02We hope you'll join us next week to
30:02 --> 30:03learn more about the fight against
30:03 --> 30:06cancer here on Connecticut public radio.

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August 30, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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