University of Virginia Health System

U.VA. STUDY SHOWS PSYCHOTHERAPY IMPROVES QUALITY OF LIFE FOR BRAIN TUMOR PATIENTS AND CAREGIVERS

Adult brain tumor patients often experience a rapid decline in thinking, memory, speech and other cognitive functions. Psychological counseling for family members can help patients and their families cope more easily with the mental and physical decline and improve quality of life for patients and their caregivers, according to a study conducted by University of Virginia researchers.

U.Va. neurosurgeon Dr. Mark Shaffrey, the study's principal investigator, and co-investigator neuropsychologist Elana Farace conducted the study, and Farace will present the results in a poster session on Monday, June 3 at a conference in Washington, D.C., titled Cancer Survivorship: Resilience Across the Lifespan, jointly sponsored by the National Cancer Institute (NCI) and American Cancer Society.

The U.Va. study was funded by NCI and is part of the university's quality of life program for neuro-oncology patients. With neurosurgeons and other cancer specialists, the treatment team includes a neuropsychologist to help patients with cognitive and quality of life issues.

For caregivers, it can be like having to take care of a patient who has Alzheimer's dementia as well as cancer, Shaffrey said. There can be a progressive loss of the patient's mental functions, in addition to the tough physical challenges they face.

Unlike patients with other cancers who may decline over several years, a patient with the most common form of malignant brain tumor has a prognosis of only six months to a year. During that time, patients' behavior, moods and ability to communicate may deteriorate sharply, along with functions like vision or motor coordination, Farace said.

In brain tumor cases, cognitive problems make up most people's concerns about quality of life, she said. In general, patients and their families can adjust to physical deficits -- you can put in a ramp for a wheelchair, for example, and make other adjustments for limited physical mobility. But what really becomes tough is when patients lose speech ability and can't communicate their needs or their feelings to family members.

How a patient's cognitive abilities change depends on the tumor's size, rate of growth and location, Farace said. For example, the left brain controls language, verbal learning, memory, verbal reasoning and right-sided dexterity; the right brain controls visual-perceptual skills and left-sided dexterity. The frontal lobe determines apathy, motivation, spontaneity, attention and behavioral inhibition; while the subcortical area controls thinking, physical coordination and memory. Radiation, chemotherapy, medications and surgery also can cause cognitive change.

In addition to evaluating quality of life for patients, the study included a randomized, controlled trial to evaluate the benefits of one-to-one counseling for caregivers of 30 patients, who received weekly psychotherapy sessions for ten weeks.

Nobody ever trains to become the caregiver for people with this disease, Farace said. We wanted to see if counseling could help improve their quality of life during this unique and stressful situation. That amount of stress can have long-term effects on the family. So even though we may not be able to ultimately change the patients' terminal prognoses, we at least helped the families function at a much better level.

Caregivers in the study needed help with how to talk to the patient about death and dying issues. Often family members were afraid that if they brought up the discussion, it might be misinterpreted as no longer having hope, Farace said. But at the same time, they knew they needed to find out what the patient wanted to have done after they died.

Farace also helped study participants deal with how to maximize a patient's independence yet still not neglect them when the caregiver lives in a separate place, and how to help someone who is diagnosed in the midst of their professional life make the transition when they suddenly have to stop working. Only 12-18 percent of patients return to work part- or full-time within three months of their diagnosis, she said.

Currently, Farace is leading another quality of life study among the parents of pediatric brain tumor patients, whose conditions tend not to be malignant, so they live longer on average than adults diagnosed with the disease. Cognitive impairment, however, still can occur in these children, affecting their education and raising concerns about independent living, insurance coverage and continued medical treatment after the patients are no longer minors.

Shaffrey and Farace are planning a third study to test the use of an anti-depressant early after diagnosis in brain tumor patients for its ability to prevent some of the depression associated with patients' decline.

As many as 17,000 Americans are diagnosed with brain tumors as a primary cancer per year, according to the National Brain Tumor Foundation, and only 30 percent of them survive five years or longer. Metastatic brain tumors -- occurring because cancer has spread to the brain from other parts of the body -- is diagnosed in more than 150,000 patients per year.

May 29, 2002