50| Non-CNS Cancer and Cognition – A Conversation With Dr. Mike Parsons

The cognitive consequences of non-central nervous system (non-CNS) cancer and cancer-related treatments did not become the subject of scientific investigation until recently and is still a growing area of research.  Contemporary studies have made it clear that neuropsychology is an integral part of the evaluation and care of individuals with cancer.  Today we talk with Michael Parsons, Ph.D., ABPP-CN, about the evaluation of cognitive change due to cancer and cancer-related treatment, factors that influence cognitive decline in these patients, and how interdisciplinary work can benefit these patients.

A pdf of the transcript for this episode is available here.

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Topics Covered

  • Review the history of scientific consideration of cognition and cancer
  • Discuss the term “chemo brain” and its history as well as implications
  • Breast cancer as a model for understanding non-CNS cancer and cognition
  • List sociodemographic factors that affect the prevalence of cognitive impairment in cancer survivors
  • List the cognitive domains that are susceptible to decline due to cancer and cancer-related treatment
  • Compare mechanisms for cognitive decline across non-CNS cancer and cancer-related treatments
  • Describe neuroimaging findings related to cognition and non-CNS cancer
  • Discuss other non-CNS cancers and cancer-related treatment related to cognitive decline
  • Discuss details regarding typical neuropsychological evaluations for adult patients with non-CNS cancer
  • Assess the claim that cancer treatments lead to accelerated aging and the mechanisms that may perpetuate age-related change
  • Characterize cognitive decline in older adults with cancer and cancer-related treatment
  • Discuss medical decision-making for older adults with cancer, including opioid use for cancer-related pain and its impact on cognition
  • Review the International Cognitive and Cancer Task Force (ICCTF)
  • Explain the importance of translational and interdisciplinary research and clinical care for the care of patients with non-CNS cancer

About Mike

Dr. Michael W. Parsons is a board-certified clinical neuropsychologist at the Pappas Neuro-Oncology Center and Department of Psychiatry at Harvard University and Massachusetts General Hospital in Boston, Massachusetts. He specializes in cancer and cognition and his clinical work primarily involves the neuropsychological evaluation of patients with cognitive issues caused by cancer and its treatment.

Conflict of interest disclosure:

Dr. Parsons has received consulting fees from Agios Inc, a pharmaceutical company working on drugs for glioma, and from Monteris Inc, the developer of a medical device for treatment of brain tumors.  The materials discussed in the podcast are not directly related to these companies.

Selected References

Ahles, T. A., Root, J. C., & Ryan, E. L. (2012). Cancer-and cancer treatment–associated cognitive change: an update on the state of the science. Journal of Clinical Oncology30(30), 3675.

Andreotti, C., Root, J. C., Ahles, T. A., McEwen, B. S., & Compas, B. E. (2015). Cancer, coping, and cognition: a model for the role of stress reactivity in cancer‐related cognitive decline. PsychoOncology24(6), 617-623.

Centeno, C., Sanz, Á., & Bruera, E. (2004). Delirium in advanced cancer patients. Palliative Medicine18(3), 184-194.

Deprez, S., Kesler, S. R., Saykin, A. J., Silverman, D. H., De Ruiter, M. B., & McDonald, B. C. (2018). International cognition and cancer task force recommendations for neuroimaging methods in the study of cognitive impairment in non-CNS cancer patients. JNCI: Journal of the National Cancer Institute, 110(3), 223-231.

Hodgson, K. D., Hutchinson, A. D., Wilson, C. J., & Nettelbeck, T. (2013). A meta-analysis of the effects of chemotherapy on cognition in patients with cancer. Cancer treatment reviews39(3), 297-304.

Holohan, K. N., Von Ah, D., McDonald, B. C., & Saykin, A. J. (2013, November). Neuroimaging, cancer, and cognition: state of the knowledge. In Seminars in oncology nursing (Vol. 29, No. 4, pp. 280-287). WB Saunders.

Joly, F., Giffard, B., Rigal, O., De Ruiter, M. B., Small, B. J., Dubois, M., LeFel, J., Schagen, S.B., Ahles, T.A., Wefel, J.S., Vardy, J.L., Pancré, Lange, M., * Castel, H. (2015). Impact of cancer and its treatments on cognitive function: advances in research from the Paris International Cognition and Cancer Task Force Symposium and update since 2012. Journal of Pain and Symptom Management, 50(6), 830-841.

Karuturi, M., Wong, M. L., Hsu, T., Kimmick, G. G., Lichtman, S. M., Holmes, H. M., Inouye, S.K., Dale, W., Loh, K.P., Whitehead, M.I., Magnueon, A., Hurria, A., Janelsins, M.C., & Magnuson, A. (2016). Understanding cognition in older patients with cancer. Journal of geriatric oncology, 7(4), 258-269.

Kesler, S. R., & Blayney, D. W. (2016). Neurotoxic effects of anthracycline-vs nonanthracycline-based chemotherapy on cognition in breast cancer survivors. JAMA oncology, 2(2), 185-192.

Mandilaras, V., Wan-Chow-Wah, D., Monette, J., Gaba, F., Monette, M., & Alfonso, L. N. (2013). The impact of cancer therapy on cognition in the elderly. Frontiers in pharmacology, 4, 48.

Wefel J. S., Parsons M. W., Gondi V., & Brown P. (2018) Neurocognitive Aspects Including Radiation Complications. In: Handbook of Clinical Neurology – 3rd Edition: Metastatic Diseases of the Nervous System. Schiff & van den Bent (Eds). Elsevier.

Wefel, J. S., Vardy, J., Ahles, T., & Schagen, S. B. (2011). International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. The lancet oncology, 12(7), 703-708.

Selected Resources

International Cognitive and Cancer Task Force (ICCTF)