152| Cancer Therapies and Brain Health – A Conversation with Dr. Mike Parsons and Dr. Jorg Dietrich
Oct 1, 2024
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Dr. Michael Parsons, a board-certified neuropsychologist specializing in brain tumors, and Dr. Jörg Dietrich, a neuro-oncologist at Harvard, delve into the complex interplay between cancer therapies and brain health. They unpack how systemic treatments like chemotherapy can lead to cognitive challenges, including the infamous 'chemo brain.' The guest experts also explore the fascinating realm of immunotherapy, its revolutionary effects, and associated cognitive risks. Their insights shed light on the vital role of neuropsychologists in assisting cancer patients navigate these challenges.
Understanding cancer biology is essential for neuropsychologists to improve patient communication and address mental health complications related to cancer treatments.
Cognitive challenges associated with non-CNS cancers can begin prior to treatment, emphasizing the need for comprehensive assessments that account for existing impairments.
Neuropsychologists are crucial in oncology settings, providing cognitive evaluations, interventions, and support, thereby enhancing patient quality of life during and after cancer treatments.
Deep dives
Understanding Cancer Biology for Neuropsychologists
Cancer biology is crucial for neuropsychologists, as it helps in understanding the disease's breadth and implications. Cancer is characterized by cells that replicate indefinitely, evade normal growth limits, metabolize nutrients to survive, and can metastasize, allowing them to spread to other areas of the body. With cancer being the second leading cause of death in the U.S., neuropsychologists must grasp its systemic effects, particularly how non-CNS (central nervous system) cancers impact cognitive function and mental health. A clear foundational knowledge helps neuropsychologists communicate effectively with medical colleagues, assess patient needs better, and navigate patient interactions regarding mental health complications related to cancer treatments.
Impact of Cancer on Cognition
Non-CNS cancers are increasingly recognized for their cognitive impacts, moving beyond the historically understood effects of brain tumors. Approximately 20% to 50% of patients with non-CNS cancers report cognitive difficulties ranging from memory issues to executive function impairments, particularly during and after chemotherapy. Research has shown that some cognitive deficits can even exist prior to any cancer treatment, likely due to the cancer's systemic effects, such as inflammatory responses and metabolic changes. Taking into account these latent cognitive challenges will allow neuropsychologists to provide more comprehensive care and targeted interventions for cancer patients.
Role of Neuropsychologists in Cancer Care
Neuropsychologists play a vital role in the treatment of cancer patients by assessing and addressing the cognitive and emotional challenges that arise due to cancer and its treatments. In specialized medical centers, they can evaluate cognitive deficits, provide interventions, and offer emotional support to patients and families, thus promoting overall quality of life. Furthermore, they can teach oncology staff about cognitive issues and help integrate mental health care into the broader treatment team. With a growing recognition of cognitive effects in cancer patients, the demand for neuropsychologists in oncology settings is increasing, creating opportunities for the field to adapt and expand.
Chemotherapy and Cognitive Function
Chemotherapy is often associated with significant cognitive side effects, commonly termed 'chemo brain,' due to its neurotoxic effects on healthy brain cells. Research indicates that these cognitive changes can be attributed to a multitude of factors including oxidative stress, inflammation, and disruptions in the blood-brain barrier, which allow harmful substances to enter. While cognitive effects are most pronounced during treatment, many patients often see improvement post-therapy; however, some patients may continue to experience persistent cognitive deficits. Understanding these dynamics is vital for neuropsychologists to provide timely interventions and support to mitigate cognitive decline following cancer treatments.
Emergence of Immunotherapy in Cancer Treatment
Immunotherapy, particularly checkpoint inhibitors, represents a new frontier in cancer treatment, effectively stimulating the immune system to fight malignancies. Though promising, these therapies can lead to adverse effects, including neurotoxicity, which pose additional challenges for neuropsychologists in managing cognitive health. For instance, cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome can result in acute cognitive decline, highlighting the need for ongoing cognitive assessment in these patients. Understanding these complications not only assists in immediate care but also informs long-term management strategies for sustaining cognitive health.
Advancements in Cancer Neuroscience
The field of cancer neuroscience is emerging, emphasizing the interaction between tumors and the nervous system, which can influence both the pathology of cancer and cognitive outcomes. Tumors can communicate with neural networks, altering their function and potentially leading to cognitive symptoms even before they become clinically apparent. Understanding this complex interplay can drive innovative therapeutic strategies and enhance neuropsychological assessments. For neuropsychologists, recognizing these relationships will be key in advancing the field and improving patient care as the nuances of cancer's impact on cognitive functions are more thoroughly explored.
In this episode on systemic, non-CNS cancer therapies and brain health, with Drs. Michael Parsons and Jorg Dietrich, we discuss basic concepts in cancer biology, the impact of cancer therapies on cognition, mechanisms by which non-CNS treatments impact brain health, the role of the immune system in treatment, immune system overactivation and cognitive side effects, the burgeoning field of cancer neuroscience, and the role of neuropsychologists in assessment, management, and treatment of patients with systemic cancers.
Thanks for listening, and join us next time as we continue to navigate the brain and behavior!
[Note: This podcast and all linked content is intended for general educational purposes only and does not constitute the practice of psychology or any other professional healthcare advice and services. No professional relationship is formed between hosts and listeners. All content is to be used at listeners’ own risk. Users should always seek appropriate medical and psychological care from their licensed healthcare provider.]
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