Cognition and cancer

drmeyers Dr. Christina Meyers, a nationally recognized neuropsychologist at M.D. Anderson Cancer Center in Houston, has done pioneering work on the effects of cancer and cancer treatment on the central nervous system. (In fact, she created the Neuropsychology Service in the newly formed Department of Neuro-Oncology at M. D. Anderson in 1984. A summary of her work can be found here.)

She edited the first textbook collection of studies on cognition and cancer — the first ever — called, appropriately enough, Cognition and Cancer, recently published by Cambridge University Press, New York. Cognition and Cancer is aimed at the doctor, researcher, or other clinician interested in delving into the science of cancer treatments and their long-term effects on the brain. In other words, it’s not an easy read for those of us who are mere mortals.

But that’s probably beside the point: it’s a significant milestone in the study of chemobrain, and clear, hard-copy evidence of the feverish pace of research into this baffling cluster of symptoms. It also provides a blueprint to the science behind chemobrain for clinicians who might not be convinced.

The preface states the mission of the book beautifully:

“This volume is different from anything that has been published in the fields of oncology and neurosciences. The study of cognitive function in cancer patients is in its infancy, and far behind the research in other diseases.”

Dr. Meyers and her colleagues recognize how important quality of life is for cancer patients and survivors. “…cognitive impairment and other adverse symptoms associated with cancer are becoming increasingly important to patients and are identified as a major source of concern for survivors.”

Dr. Meyers and Dr. James Perry, head of the neurology division at Sunnybrook Health Sciences Centre at the University of Toronto, elaborate in their introduction.

cognition

“Cancer treatment may only be considered successful if these symptoms are managed, but successful management is hampered by insufficient knowledge of mechanisms…. The effect of these symptoms on daly life can be quite profound, depending upon the demands present in the individual’s work and home life. Many patients observe that they can no longer multi-task, and that they may become overwhelmed when too much is happening at once. They are often easily distracted, and find that they may go from project to project without getting them done.”

The impact of cognitive dysfunction can depend on a patient’s stage of life: an older, retired person who can take things at his or her own pace might find it easier to cope than an attorney in a court-room setting, who might have to change jobs or go on disability.

I talked with Dr. Meyers by phone to ask what’s next.

Q: What need is this book fulfilling?

A: The study of cancer and cognition is in its infancy, in one respect. There is a huge amount of information out there already, but it is not filtering down to the practitioners. So there are still people who deny that chemobrain exists, who assume it is some kind of psychiatric issue. In fact, there is a lot of good science behind it.

Q: Why do you think practitioners, particularly oncologists, seem to be slow to recognize this?

A: I think they’re not aware of the scientific literature about it, for one thing. Part of it may be an ego issue for some. They want to put this person in remission, on a path to a cure, and now they’re complaining.

Q: The attitude you’re describing is what some patients experience. They’re told, ‘You should be grateful to be alive.’

A: Right, that’s kind of the attitude. That used to be the attitude toward pain, and we finally got that pretty well taken care of. And also fatigue, which has a lot of scientific background. The bottom line is that there has been this nihilistic attitude, that this is what you expect when you go through cancer treatment. And that is just not enough for the consumer any more.

Q: What about long-term effects?

A: It’s a societal issue. If you can’t return to work effectively, if you have these symptoms that are not being addresed, you are not going to get back to your life like you did before. It’s going to have all kinds of downstream social costs and issues.

I think that cancer patients need to be vocal advocates — like they are with insurance companies and everything else. And that their symptoms should be treated with as much respect as their cancer would be treated.

Q: Talk a little about the  ‘seed, soil, and pesticide’ analogy that you use in the book.

A: You have to take all three issues into account. You have the cancer itself (the seed), you have the body’s reaction to the cancer and your own personal genetic makeup (the soil), and you have specific agents that are used to treat the cancer (the pesticide).

Q: Could the cancer itself be causing some chemobrain effects?

A: Yes. It could be an inflammatory response, where your body knows that something is wrong — just as your body knows something is wrong when it has a virus. And some cancers secrete things that could cause symptoms. Or you might have an autoimmune response to the cancer. People will tell me that they felt funny before their cancer was diagnosed, they couldn’t put their finger on it, but something just wasn’t right.

Q: Where would you like to see the research go?

A: Right now there is a lot of new animal work that is being done, and it is very exciting. It is looking at the precise mechanisms by which these agents cause problems, even if they don’t cross the blood-brain barrier. And we know tht some of these agents certainly can influence the blood-brain barrier. This research will eventually lead us to targeted treatment and to ways to prevent symptoms. The ultimate goal is that you don’t have [chemobrain] symptoms to begin with.

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