Neuropsychology and Brain Cancer
August 31, 2020Information
August 30, 2020
Yale Cancer Center
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- 00:17Welcome to Yale Cancer Answers with
- 00:19your host Doctor Anees Chagpar.
- 00:22Yale Cancer Answers features the
- 00:24latest information on cancer care
- 00:26by welcoming oncologists and
- 00:27specialists who are on the
- 00:29forefront of the battle to fight
- 00:31cancer. This week it's a
- 00:33conversation about neuropsychology
- 00:34and brain cancer with doctor
- 00:35Franklin Brown. Doctor Brown is an
- 00:38assistant professor of neurology
- 00:39and chief of the division of
- 00:41neuropsychology at the Yale School
- 00:43of Medicine where Doctor Chagpar
- 00:45is a professor of surgical
- 00:47oncology.
- 00:50Dr. Brown, maybe we can start
- 00:52off by you telling us a little bit
- 00:56about what exactly is neuropsychology,
- 00:58and how does that
- 01:00interface with the world of cancer?
- 01:03Neuropsychology is really
- 01:04the study of cognition.
- 01:06Things like memory,
- 01:07attention span, language skills,
- 01:09visual spatial skills,
- 01:11all these different things that
- 01:13your brain does on a daily basis to
- 01:17basically think and talk and interact.
- 01:20So that's basically what the field
- 01:22looks at within brain tumors.
- 01:24It's important because it helps assess
- 01:27the impact of brain tumors on cognition,
- 01:30but we can also use it to predict
- 01:33in some cases what might happen
- 01:36if the tumor is removed,
- 01:38and it also might help guide
- 01:41various methods of removal in
- 01:43some cases so it can help guide
- 01:46the impact of the tumor removal,
- 01:49but also help the patient
- 01:51and health care providers understand
- 01:53the impact after it happens
- 01:54and also help guide therapies.
- 01:56And I can imagine that if somebody is
- 01:59diagnosed with a brain tumor,
- 02:01I mean just the concept and
- 02:03the words itself makes you think, Oh my gosh,
- 02:06what's going to happen?
- 02:09Am I going to be able to think,
- 02:12am I going to lose my IQ?
- 02:14Am I going to be able to speak?
- 02:18I'd imagine that there are a lot of
- 02:21factors that go into that in terms of
- 02:24where in the brain is this tumor and
- 02:27what part of the brain does it affect?
- 02:31Tell us a little bit more about
- 02:33how you do that and how you
- 02:37help patients and clinicians
- 02:39get a sense of what this brain
- 02:42tumor is doing and what
- 02:44the ramifications of treatment are.
- 02:46As you can imagine,
- 02:48there all kinds of brain
- 02:51tumors and they are discovered in
- 02:53different ways. One way that
- 02:55my field tends to interact a lot with brain
- 02:58tumors can be from seizures.
- 03:00In epilepsy there are some patients that
- 03:02will randomly start developing seizures,
- 03:04and as part of the work up they might
- 03:07find the tumor and in some cases it
- 03:09might be a very slow growing tumor,
- 03:12in which case they might watch it for awhile
- 03:15and they may not do anything with it,
- 03:17because it might discover that it's been there
- 03:20for the patients whole life for
- 03:21most of their life,
- 03:23and sometimes the resection or the
- 03:24taking of the tumor might actually
- 03:27put them at risk, so the slow growing to
- 03:30more or less stable tumor like that,
- 03:34it's much more of a thoughtful process
- 03:36and I would evaluate them and then we would
- 03:40test to see OK,
- 03:41what are there risks in this case?
- 03:44And so in that kind of tumor it's
- 03:46I'm sure it's scary for that patient.
- 03:49Have a tumor, but I think in those cases
- 03:51that doctors are pretty clear of, well,
- 03:54this might have been their whole life.
- 03:56We don't know if it's growing,
- 03:58we can kind of look at this and take
- 04:00our time and figure out the next step.
- 04:03So in that kind of situation I don't.
- 04:06I mean, I'm not.
- 04:07I've not had that happen to me,
- 04:10but I don't imagine it sounds quite as
- 04:12urgent as in cases where there is a
- 04:15tumor that appears to have grown abruptly,
- 04:18and that can be quite scary for the patients,
- 04:21and so in those cases there's not
- 04:23the time for me to kind of do a
- 04:26presurgical work up and help them
- 04:28figure out the next step.
- 04:30In those cases where the tumors fast moving,
- 04:33I'm sure it's much scarier for people.
- 04:36Because it's so fast and many times I
- 04:38cannot help at that point it's you know.
- 04:41Like for example, this,
- 04:43the surgeon might have to go in
- 04:45and operate right away,
- 04:47and so there's not even any time for the
- 04:50patient to process what's about to happen,
- 04:52let alone have them see me to
- 04:55predict what's going to happen.
- 04:57So in those cases, it's much more of a.
- 05:00I'm following up,
- 05:01and I'm seeing how they're doing afterwards,
- 05:03but as you can imagine.
- 05:06If it's a fast moving tumor,
- 05:07the patient just wants to know
- 05:09that they're going to live there.
- 05:11Not worried about what I do.
- 05:13In most cases, they just want to be OK,
- 05:16'cause you know the brain tumor.
- 05:17It's gotta be a scary thing to hear a doctor,
- 05:20say to you.
- 05:21You know, I can't imagine how,
- 05:23how fearful that is.
- 05:24But like I said,
- 05:25there's different types and
- 05:27more slow growing ones.
- 05:28I'm sure the doctors can describe
- 05:30those in a com away,
- 05:31then when it's OK,
- 05:32it's a tumor we have to
- 05:34go and operate tomorrow. I can't
- 05:36imagine how scary that would sound.
- 05:38Yeah, and I would imagine that you know,
- 05:42there's certainly a balance between
- 05:44the symptoms that the brain tumor
- 05:47is causing by being in your brain.
- 05:49So for example, the seizures that you have
- 05:52that maybe there on a daily or weekly
- 05:56basis versus the potential disabilities
- 05:58that you may have with resection.
- 06:01How do you kind of balance that in
- 06:04patients who might be thinking about,
- 06:07you know, do I undergo a treatment,
- 06:10whether it's surgery or radiation?
- 06:13Versus do I live with this tumor if if
- 06:15they're kind of facing that dichotomy,
- 06:18how do you kind of counsel them?
- 06:20So if
- 06:21it's if it's a creditor that you describe,
- 06:24which is usually the type that's not.
- 06:27That did not going to die
- 06:29immediately if it's not taken out.
- 06:31There are of course case
- 06:32where there's whether it so,
- 06:33like if you don't take this out,
- 06:35that's going to be it. You know,
- 06:37I'm sure that those are the squirrels,
- 06:39but the kind that you were talking about
- 06:41are the ones that we actually have time to.
- 06:44Maybe evaluate them before surgery and the
- 06:46way that the test student works is well,
- 06:48so will test different things.
- 06:49Like I said,
- 06:50the language in different kinds of memory,
- 06:52and if it turns out that that part
- 06:54of the brain with the tumors in
- 06:56is not working properly anyways.
- 06:58Like let's say the tumors in the
- 07:00part of the brain that's important
- 07:02for verbal memory and verbal memory
- 07:04is terribly impaired at that point.
- 07:06But that point we could say to them,
- 07:08while you know there's very little
- 07:10risk because you're already having
- 07:12a lot of problems here,
- 07:13and it's unlikely to get much worse,
- 07:15and it might actually get better.
- 07:17In that conversation,
- 07:18the patient can take oh OK,
- 07:20well,
- 07:20so this is just causing problems and if he
- 07:24takes it out of something to get much worse.
- 07:27In other cases,
- 07:28if the paint,
- 07:29let's say a patient,
- 07:30is very high functioning and
- 07:32they have no problems and their
- 07:34memories all their memory is great
- 07:36and the tumors in a spot that if
- 07:38they take it out it might impact
- 07:40some important cognitive function.
- 07:41You know,
- 07:42let's say the persons a physician
- 07:44or a physicist or chemist or an
- 07:46engineer or or just anybody who's
- 07:48brain is doing just fine is now told
- 07:51that we the doctor may want to cut
- 07:53out or take out part of their brain.
- 07:57Naturally,
- 07:57if there's if there's no pre existing
- 08:00impairment from the tumor itself,
- 08:02then you've gotta start asking.
- 08:03Is this worth it?
- 08:05And I think that in many cases
- 08:07that depends on what's going on
- 08:09with the neurosurgeon.
- 08:11By say,
- 08:11let's wait and watch and see
- 08:13if it even grows.
- 08:15There might be other alternatives.
- 08:17For example,
- 08:18maybe they'll try chemotherapy
- 08:20or focused radiation therapy.
- 08:21You know,
- 08:22that's where it really gets in
- 08:24the thick of what we want to do,
- 08:26but I think that's really the next,
- 08:28you know,
- 08:29there's excellent conditions
- 08:30in various places in it.
- 08:31Yeah,
- 08:32we have some very good ones that are very
- 08:34good at detecting what can be taken out,
- 08:37so they might take out part
- 08:38of it but leave in part,
- 08:40which sounds scary.
- 08:41But it might be that if
- 08:43they leave in that part,
- 08:44there's a low risk for recurrence.
- 08:46So there's many factors taken into account.
- 08:48And believe me,
- 08:49when the neurosurgeon has that
- 08:51meeting with the patients.
- 08:52They have looked at all different
- 08:54options and I have to say
- 08:56that the ones that I work with
- 08:58their very thoughtful and very
- 09:00much do not just say OK,
- 09:02let's take it out.
- 09:04Unless of course it's vital
- 09:05for their life, you know.
- 09:07So it does depend the type.
- 09:09But Yes, there's many ways
- 09:11that we could be careful to
- 09:13reduce the risk after surgery.
- 09:15So how exactly does that happen?
- 09:17I mean, when we think about,
- 09:19you know the neurosurgeon
- 09:21going in there to take out.
- 09:23Part of the brain where the tumor is.
- 09:26But you know making sure that they
- 09:29don't damage other parts of the brain,
- 09:31that the tumor might be next to that.
- 09:35If they they do take out or or damage
- 09:38that area that the patient could be
- 09:41left with severe deformities in terms
- 09:43of you know their memory or their
- 09:46cognition or their language skills.
- 09:50Can the surgeons actually see which areas
- 09:53which or do they need fancy image Ng?
- 09:56Or is there a way that that's done with?
- 10:00You know, while patients are awake,
- 10:02I know that we've all seen kind
- 10:04of shows on people taking care
- 10:06of seizures with patients awake.
- 10:09How does that happen for patients
- 10:11with cancer?
- 10:11So this is
- 10:13a great question, and there's a
- 10:15lot of tools that are now used
- 10:17before the surgeon even goes in.
- 10:19They have all these kinds of data.
- 10:22I have time.
- 10:23They've done different kinds of Mris.
- 10:25There's a kind of MRI called
- 10:27diffusion tensor imaging,
- 10:28which actually tracks the
- 10:30pathways in the brain because.
- 10:32What are the biggest risks with
- 10:33surgery is if they if they hit a
- 10:35pathway they might not hit this
- 10:37Center for some kinds of ticket.
- 10:39But if you hit the wrong path
- 10:40way you know could cause
- 10:42some pretty global problems.
- 10:43So with all the image Ng
- 10:45data that's available today,
- 10:46there are many ways that before
- 10:47they even go in they already have
- 10:49an idea of what they're going to
- 10:51say that I can't speak for them,
- 10:53but in the in the T meetings that
- 10:55have been part of pretty much they
- 10:57have an eye discharge and has a very
- 10:59good idea exactly what they're going
- 11:01to take out before they ever go in.
- 11:03Now, sometimes once they're in,
- 11:05they'll find the tumors more extensive
- 11:07or has something more to problem,
- 11:08but they were.
- 11:10They are very careful.
- 11:12You know, and that's that's really the key.
- 11:14Now the other pieces.
- 11:16Sometimes there is awake intra
- 11:18operative map and it's called and
- 11:20that means the patients actually
- 11:22kept awake and some like myself
- 11:24or other providers or even the
- 11:26surgeon will talk to the patient
- 11:29while doing the surgery to kind of
- 11:31predict what's going to happen.
- 11:33And there might.
- 11:34They might even use a little
- 11:37stimulation to kind of determine OK,
- 11:39if we you know the stimulate the
- 11:42area around the tumor to find out.
- 11:44If they stimulate certain parts,
- 11:46is it stopped language?
- 11:48This language continue,
- 11:49so sometimes during the actual
- 11:50procedure the patient will be awake
- 11:53and areas are under tomorrow be
- 11:55stimulated to find out what would impact.
- 11:57The impact would be if that
- 11:59part was taken out.
- 12:00So it's really quite amazing what
- 12:02what they do in the neurosurgery
- 12:04suite during these cases.
- 12:06And now there's all kinds of newer tools.
- 12:09There's a laser ablation therapy
- 12:11where they'll take a laser and it's
- 12:13like a same day procedure where they.
- 12:16The next day, their home.
- 12:19Of course.
- 12:19Is there radiation types,
- 12:20but but there are a lot of
- 12:22different ways now that the surgeon
- 12:24has to really know exactly what
- 12:26they're going to be further going,
- 12:28and so we will work with them.
- 12:30We will have them do what's
- 12:32called a functional MRI,
- 12:33which Maps were different language
- 12:35and other cognitive functions
- 12:36might be occurring will do our
- 12:38testing to kind of find out.
- 12:40OK,
- 12:40that tumor is in this area that
- 12:42braid it would affect this function.
- 12:45But see how that functions working now.
- 12:47Let's predict what's going
- 12:48to happen afterwards,
- 12:49so it's really by the time
- 12:51they go into surgery.
- 12:52Unless it's an emergency situation,
- 12:54there is a lot of planning,
- 12:56and they pretty much know.
- 12:58With a fairly good,
- 12:59certainly what's going to happen before
- 13:01the surgery even occurs.
- 13:02That way, the patient and their
- 13:04family could be talked about.
- 13:05OK, here's what to expect.
- 13:07Now of course, every once awhile
- 13:09there might be a surprise,
- 13:11and that's always your risk.
- 13:12But many times that we really
- 13:14strive so they know what to expect
- 13:16before it even happens.
- 13:17Yeah, I mean, it really is cool how
- 13:19far surgery and technology is come.
- 13:21It's kind of. It's kind of weird to
- 13:23think about having somebody take out
- 13:25a brain tumor with you being awake.
- 13:27But on the other hand, it really is
- 13:30pretty cool that you know you can.
- 13:32You can give the surgeon
- 13:33real time feedback of,
- 13:34you know if you go in that spot.
- 13:37I'm going to stop talking,
- 13:38and if you go in that spot.
- 13:40I'm going to start shaking and and so on.
- 13:44You mentioned things like Lazaran radiation.
- 13:47Are those more or less toxic to
- 13:50your brain in terms of causing side
- 13:53effects in terms of a bleeding tumors?
- 13:56I mean, are they better in
- 13:59terms of reducing the cognitive
- 14:01side effects of having your
- 14:04cancer treated well?
- 14:05I know more about laser ablation from
- 14:08the epilepsy patients at that time.
- 14:11Part of seeing and I know that in
- 14:14the research, a good friend of mine,
- 14:16there's a lot of these another institution,
- 14:19and they've had a large data set
- 14:21of patients and they find that
- 14:23the laser ablation has very has at
- 14:25least Kogda Side Effects afterwards,
- 14:27and we've actually learned that the
- 14:30laser ablation you could take out
- 14:32parts that traditional surgery.
- 14:34It would have damage to surrounding area,
- 14:36but laser ablation might be able to
- 14:39pinpoint a very precise location so
- 14:41that actually has fewer cognitive risks.
- 14:44And in terms of radiation,
- 14:46you know there's more focused beam
- 14:48radiation that they use now they
- 14:50used to use whole brain radiation,
- 14:52which was not good because that would
- 14:55affect the whole brain as as a name implies,
- 14:58it's a whole brain.
- 15:00Radiation would impact the cognition
- 15:02in a larger degree.
- 15:04Whereas focused beam radiation
- 15:05would affect that area.
- 15:07Now the risk to radiation is that is
- 15:10not just a time that's being used,
- 15:12but there's also after effects,
- 15:14so the radiation might continue
- 15:16to affect the area of the brain.
- 15:19So some of the cognition might actually
- 15:21decline a little bit after the surgery,
- 15:24after the radiation is even
- 15:26over down the road,
- 15:27you can have a little bit of
- 15:29decline in that immediate area.
- 15:31So yeah,
- 15:32no sorry.
- 15:33So this is. Really fascinating
- 15:35in terms of how we can influence
- 15:38our cognition while still
- 15:40taking care of brain tumors.
- 15:42We need to take a short break
- 15:45for a medical minute,
- 15:47but will learn more right after this
- 15:50break with my guest. Doctor Franklin Brown.
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- 16:45This is been a medical minute brought to you
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- 16:57Welcome
- 16:58back to Yale cancer answers.
- 17:00This is doctor in East shag part
- 17:02and I'm joined tonight by my guest
- 17:05doctor Franklin Brown were talking
- 17:07about neuropsychology and brain
- 17:09cancer and right before the break.
- 17:11Franklin we were talking a little bit
- 17:14about surgery versus radiation which
- 17:17can be focused or even lasers which can
- 17:20be perhaps even more focused where you
- 17:22know we can really address brain cancers
- 17:25without affecting the entire brain.
- 17:27Now the. The other modality,
- 17:29of course that is sometimes used
- 17:32is is chemotherapy and, you know,
- 17:35chemotherapy can affect your brain to a
- 17:38lot of people talk about chemo brain.
- 17:41Can you talk a little bit about how
- 17:44exactly does chemotherapy affect your brain?
- 17:47I mean, it's certainly not a structural
- 17:50thing of taking actual brain tissue out,
- 17:53but it seems to still
- 17:55affect people's cognition was sure,
- 17:57and in fact, chemo.
- 17:59Chemotherapy, while it's important,
- 18:01can leave comments effects
- 18:02regardless of the type of tumor.
- 18:04Sowerby regards the type of cancer,
- 18:06so we're talking about brain tumors,
- 18:09but in any kind of cancer
- 18:11that chemotherapy is used,
- 18:12it can cross the blood brain barrier,
- 18:15an effect the brain now.
- 18:17The way this typically happens in the brain,
- 18:20there's what's called the Gray matter,
- 18:22which is where our actual thinking sells.
- 18:24For like, a better term would be located.
- 18:28But then this was called the white matter,
- 18:31which connects to different parts of the
- 18:34brain together and that white matter
- 18:37is very important for functioning
- 18:39but also for function efficiently.
- 18:41So let's say that the chemotherapy because
- 18:45it affects the person's general health.
- 18:48This effects white matter.
- 18:50More than Gray matter.
- 18:52In fact,
- 18:53it tested target white matter because white
- 18:55matters affected by the body's health, so.
- 18:58You have the white matter that gets
- 19:01affected by chemotherapy and afterwards
- 19:03patients have they feel foggy there.
- 19:06Say they can't focus very well.
- 19:09They're complaining memory problems,
- 19:10and it really comes down to the brain
- 19:14not communicating efficiently anymore.
- 19:16And so it's.
- 19:17There's different networks in the brain.
- 19:19So let's say the actual.
- 19:21Like I said,
- 19:23the brain centers might be intact,
- 19:25but the communication between
- 19:27those centers are slowed down.
- 19:30Therefore,
- 19:30kits at a sink.
- 19:31So imagine one way it imagine this
- 19:34is like if you're very tired.
- 19:36Let's say that you only got a few
- 19:38hours sleep the night before and the
- 19:41next day you're feeling kind of foggy.
- 19:43You can't think as well.
- 19:45You mind might wander,
- 19:47you know all those things that you feel
- 19:50when you're very tired and in a way,
- 19:52this is kind of what chemotherapy
- 19:55does the brain.
- 19:56Because it makes it less efficient.
- 19:58Your brain. It takes a lot more.
- 20:00For to do things.
- 20:02So this will result in the
- 20:04person feeling tired, unfocused.
- 20:06You know other factors that make
- 20:09them less able to pay attention
- 20:11to what's going on,
- 20:12so cognitive efficiency is actually
- 20:15is one of my areas of interest
- 20:18is very vital for thinking.
- 20:20Paid attention.
- 20:21You know finding towards another
- 20:24actions that are required
- 20:26that chemotherapy affects so
- 20:29you know, having thought about that right?
- 20:32So especially when there is
- 20:35some time to prepare, right?
- 20:37So usually, regardless of whether
- 20:40somebody is taking out a piece
- 20:43of brain from brain tumor or
- 20:45planning some focused radiation,
- 20:48or whether you're going to be
- 20:51getting some chemotherapy.
- 20:53For brain cancer or any
- 20:54other cancer for that matter,
- 20:56oftentimes there's some preparatory
- 20:57work that goes into that,
- 20:59and we had talked before the break
- 21:00about you know certainly in preparation
- 21:02for brain surgery to remove tumors
- 21:04that there's functional MRI's,
- 21:06and so on and so forth.
- 21:08So you have some time now I can
- 21:10imagine that a lot of people who
- 21:12might be listening to this show might
- 21:15be asking themselves, you know,
- 21:17is there something I can do?
- 21:19In that period of time when I know
- 21:22that my brain is going to be affected
- 21:25by whatever treatment is to come,
- 21:27is there something that I can do to help
- 21:30myself preserve some of my cognition?
- 21:32You know whether that is particularly a
- 21:35particular diet that I should be eating,
- 21:37or particular vitamins that
- 21:38I should be taking,
- 21:40or whether I should be doing
- 21:42more crossword puzzles and trying
- 21:44to keep my brain active?
- 21:45Like what advice do you have,
- 21:47or is there any advice?
- 21:50For helping people to kind of
- 21:52shore up their their brainpower,
- 21:55their cognition to best withstand
- 21:57the insult that is about to occur.
- 22:01Well, one of the things that a lot of
- 22:04people may not realize is that your
- 22:06brain health things that make your
- 22:09brain healthy are the same things
- 22:11that make your heart healthy and in
- 22:13fact was a big connection between
- 22:15brain health and heart health.
- 22:17In other words, if someones if
- 22:19someone's cardiovascular system is is
- 22:21at risk than their brain function,
- 22:22it can be at risk,
- 22:24which is a whole other topic,
- 22:26but I think that one of the big things
- 22:28is the healthier person is going
- 22:31into a therapeutic situation like
- 22:33chemotherapy or radiation or whatever.
- 22:35The better the outcome generally,
- 22:37so this means that if the person is
- 22:40someone that exercises fairly regularly,
- 22:43eats fairly healthy and you know
- 22:45there's other things like that,
- 22:48then they are going to be at
- 22:51lower risk in general.
- 22:53After surgery for cognitive problems
- 22:55that people that let's say or less
- 22:58healthy that might have some medical
- 23:00risk factors like high blood pressure,
- 23:03high cholesterol,
- 23:04maybe they don't exercise really.
- 23:06Maybe they are overweight,
- 23:07you know there's all these things that
- 23:10the more of these problems that occur,
- 23:13the higher risk your brain is for.
- 23:16For not being as healthy both
- 23:18before and then after a surgery.
- 23:20Sleep is also very important,
- 23:22so following good sleep hygiene
- 23:24recommendations is important,
- 23:26but if you have someone that doesn't
- 23:28exercise from that doesn't sleep well,
- 23:30maybe they work long hours.
- 23:32You know these are all things that
- 23:35that when you think of Health,
- 23:37the more or less healthy person
- 23:39is a more cognitive risks they
- 23:41have and vice versa.
- 23:43So definitely that affects
- 23:45the other thing is also mood.
- 23:47You know it could be very upsetting to
- 23:50find out someone has cancer and that
- 23:52can affect the person pretty rapidly.
- 23:54So the other thing is how do
- 23:57you keep your mood up now?
- 23:59Of course there are answer,
- 24:00depresses and things like that.
- 24:02But I'm actually a big a big believer
- 24:05in therapy and so I really think that
- 24:08when someone gets diagnosed with cancer.
- 24:10To me,
- 24:11I mean maybe I'm biased,
- 24:12but from my perspective think if they
- 24:15could all have access to accounts are.
- 24:17Added time and after the diagnosis to
- 24:20help them reframe their way of thinking,
- 24:22deal with their anxiety.
- 24:24So they can decrease depression
- 24:26and anxiety going into it.
- 24:28They're going to be better off
- 24:30shape when they come out of it.
- 24:33So things like that are very important.
- 24:35An I mentioned sleep briefly.
- 24:38There is growing evidence that sleep
- 24:41definitely affects the brain functioning.
- 24:43Whether it's long term,
- 24:45for example sleep,
- 24:46chronic seat problems are associated with
- 24:48a higher risk of Alzheimer's disease,
- 24:50or whether it's short term.
- 24:52Adjust the immediate effects of fatigue.
- 24:54Obviously,
- 24:55if someone's having chronic sleep problems,
- 24:57they're going to be more fatigue
- 24:59and had more difficulty focusing.
- 25:01Those things are also really important
- 25:03for recovery from any kind of whether
- 25:06it's a direct brain resection,
- 25:08radiation therapy,
- 25:09or chemotherapy.
- 25:10So those are the things that.
- 25:12I think in the idea world,
- 25:14if we could really help the
- 25:16patients go into it healthy.
- 25:18Focus on it in a healthy way.
- 25:20Help help deal with feelings
- 25:22of depression, anxiety.
- 25:23They're going to come out
- 25:25with it out of it much better.
- 25:28So it definitely there are ways
- 25:30that that you can improve a
- 25:32person's outcome in their risks.
- 25:34Yeah, you know, all of that makes
- 25:37me think about stress as well.
- 25:39And you know, the the kind of
- 25:42correlations between stress and
- 25:43inflammation and an cancer in general,
- 25:46but it sounds like kind of
- 25:48regulating your stress might
- 25:50might be helpful in terms of.
- 25:52Preserving your brain function
- 25:53as well are are there data on
- 25:56that and an any particular things
- 25:58in terms of stress reduction,
- 26:00whether it be meditation or you
- 26:03certainly mentioned exercise.
- 26:05Right, so absolutely stresses
- 26:07deftly can be toxic to the brain.
- 26:11That there's been in decades past.
- 26:13There's a lot of research and stress
- 26:15and anxiety in the brain and there it
- 26:18actually stress levels can actually impact
- 26:20the size and volume of a memory center
- 26:22of the brain called the hippocampus.
- 26:24There were states that they did in the
- 26:2680s and 90s where they actually found
- 26:29that people with higher levels of stress
- 26:31will have smaller memory centers like that.
- 26:33The campus and then after they
- 26:35get treated for that stress,
- 26:37the MRI actually shows some
- 26:39rebounding of the size,
- 26:40which is unbelievable but is amazing so.
- 26:42Absolutely, you know, stress is such
- 26:45an important thing to help cope with,
- 26:48and I think that you know
- 26:50when someone's here.
- 26:52We get diagnosed with cancer.
- 26:54There focused might just be an OK I want to.
- 26:58I want to survive.
- 27:00I want to be healthy,
- 27:02but the way they survive in the
- 27:04way they feel is absolutely vital.
- 27:07So things like obviously just
- 27:09you know talking therapist really
- 27:11helpful thing mindfulness meditation.
- 27:14Some people also do well with
- 27:16what's called cognitive imagery,
- 27:17where they are asked to imagine the
- 27:19situation so they calm down and imagine
- 27:22it working out at a certain way.
- 27:25There's been studies in various areas
- 27:27that find that guided imagery where
- 27:29person imagines their outcome seems to
- 27:31produce a sense of better self control
- 27:34and had better locus of control,
- 27:35which seems to help their outcomes.
- 27:38You know,
- 27:38so definitely the level of stress
- 27:40is very important,
- 27:41and the more we can treat that
- 27:44and reduce the level of stress
- 27:46before and after surgery,
- 27:47the better the outcome.
- 27:49And of course it better the quality of life.
- 27:52You know.
- 27:53If someone is feeling depressed and
- 27:55they feel like they're hopeless.
- 27:57And they feel like there's no
- 27:59way out and they look at their
- 28:01health and they just can't imagine
- 28:03that it's going to workout.
- 28:04They're not going to do well,
- 28:06no matter what an versus someone
- 28:08that has an optimistic viewpoint.
- 28:09It says, OK, well, this is not a big deal.
- 28:12The doctor said that this could work,
- 28:14and I know it's going to work fine,
- 28:17and they imagine it's going to work.
- 28:19It's really remarkable.
- 28:20The difference in outcomes
- 28:21then, and that's where I think
- 28:23that that talk therapy can
- 28:25really help. But you mentioned.
- 28:27Yes, so there's a kind of typical
- 28:30cognitive behavioral therapy. An.
- 28:32That's when people that with the
- 28:34provider works would help the
- 28:36person to reframe their thinking.
- 28:38So maybe they could take
- 28:39something and instead thinking
- 28:41negative negatively about it,
- 28:42think more positively and effects
- 28:44to give you an example of a
- 28:47different area in multiple sclerosis
- 28:48which also affects white matter.
- 28:50And I mention chemotherapy
- 28:52effects white matter.
- 28:53There's actually evidence that people
- 28:55that have multiple sclerosis who go
- 28:57through constant behavioral therapy
- 28:59have fewer relapses in there and
- 29:01their white matter looks better.
- 29:03So there is definitely evidence
- 29:05that talk therapy, guided imagery,
- 29:08relaxation, meditation, sleeping well,
- 29:09eating well and healthy exercise
- 29:12are very helpful.
- 29:13And cancer is actually some empirical data.
- 29:16That exercise helps recovery cognitive
- 29:19remediation which is like like
- 29:21things like speech therapy or or
- 29:24focused therapy to help someone's
- 29:26memory or compensation strategies.
- 29:28All these things have been found
- 29:31empirically to help the outcomes.
- 29:34Of people that go through chemotherapy,
- 29:36but definitely stress, I think,
- 29:38is definitely underlying factor
- 29:39in all these interventions.
- 29:41Doctor Franklin Brown is an assistant
- 29:44professor of neurology and chief
- 29:46of the division of neuropsychology
- 29:48at the Yale School of Medicine.
- 29:50If you have questions,
- 29:52the address is canceranswers@yale.edu
- 29:54and past editions of the program
- 29:56are available in audio and written
- 29:58form at Yalecancercenter.org.
- 30:00We hope you'll join us next week to
- 30:02learn more about the fight against
- 30:04cancer here on Connecticut public radio.