Neuropsychology and Brain Cancer

August 31, 2020

Information

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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16:57Welcome
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.