Cognition and Cancer

A total of 1,762,450 new cancer cases and 606,880 deaths from cancer were expected to occur in the US in 2019 (American Cancer Society).

Radiotherapy is frequently employed to control tumors that can't be removed surgically, while chemotherapy is frequently used to control metastatic or cancers that have spread to other organs. Patient survival rates continue to improve with new treatments. However, many cancer survivors suffer impaired cognitive function after receiving chemotherapy (“chemobrain”) or radiotherapy (“beamobrain”).

Reducing cognitive deficits in cancer patients

It is estimated that 28–75% of cancer patients who are treated with chemotherapy subsequently experience difficulties with concentration, memory, multi-tasking and planning ability. “Chemobrain” is thus a major quality-of-life issue for many patients. The loss of cognitive function in children who have received combined chemotherapy and radiation for brain tumors is an increasing concern as survival rates have improved. There are currently few options to prevent patients from suffering losses in cognitive performance after treatment.

CINID’s unique collaboration allows researchers to investigate how cancer treatments are leading to the loss of advanced cognitive functions (executive functions). CINID researchers have used a donation from the Cottell family to develop leading-edge instrumentation that is being used to determine how neural network function is harmed by both chemotherapy and radiation.

Clinical

Unlike chemobrain, beamobrain, or impairment after radiation therapy, is far less well understood including how much it affects patients or how long those effects will last. Few studies examine neurocognitive loss in adults. The typical way to evaluate neurocognitive function is for patients to be formally enrolled in studies where extensive testing is used. Many of these tasks are subjective, and can be heavily influenced by a patient's level of education. The testing takes a significant amount of time for patients and staff, and is often considered a chore. We are investigating the use of a rapid (5-7 minute), objective, easy-to-employ touchscreen assessment that measures several neurocognitive parameters in our patients receiving radiotherapy. The tests provide critical data on the incidence, severity and duration of beamobrain. In addition, we hope to enhance our patient’s visits to Sentara Norfolk General and EVMS clinics by playing this fun mind puzzle. We hope to alleviate the boredom of waiting times, and provide a mental distraction prior to treatment.

Translational

Clinical fMRI studies have identified several nodes in the brain where activity simultaneously turns on or off when a person performs a task. This complex balance of switches greatly affects behavior. Some brain nodes are task-negative, where activity decreases during a task. Others are task-positive, where activity increases during task. These nodes are like children on a seesaw, with activity going down in one while, at the same time, the other has increased activity. In healthy individuals the DMN network is task-negative, taking charge during rest, but deactivated when a person performs a task. Patients treated with chemotherapy and/or radiotherapy appear to be unable to regulate the seesaw activity of the DMN network. When task-positive pathways turn on, DMN should be less activated. Instead, unlike the seesaw children, it remains high. We are using our unique expertise in neural interplay to learn why, after cancer therapy, this breakdown occurs.

Cognition Working Group

• Richard A. Britten, PhD
• Hamid Okhravi, MD