Neuro-Oncology Cognitive Clinic

The Neuro-Oncology Cognitive Clinic at Froedtert & The Medical College of Wisconsin specializes in helping cancer patients cope with cognitive, behavioral and emotional changes that may be caused by their disease and/or treatment. The clinic is unique in the region.

When someone has cancer, he or she may experience a lesser known side effect of the disease and/or treatment. The side effect involves changes in cognition — a person’s ability to think, reason and perceive. A person’s behavior and emotions may also change. These changes may occur because cancer in the brain (a brain tumor) or cancer treatment can affect the way the brain works.

Cognition includes the ability to:

Understand and perceive information
Concentrate or pay attention
Perform multiple tasks at once
Reason or make judgments
Plan and organize
Learn and remember
Read
Solve problems

Cancer and/or cancer treatment may cause changes in cognition, such as difficulty concentrating, mental slowing, memory loss, problems understanding or problems organizing thoughts. Cognitive problems are also referred to as cognitive deficits or cognitive dysfunction.

Behavioral and emotional problems related to cancer and/or cancer treatment may include anxiety, depression, irritability, mood swings, and changes in personality, such as irrational behavior or inappropriate social behavior.

In terms of cancer, cognitive, behavioral and emotional changes may be caused by:

A brain tumor — each year, more than 200,000 people in the United States are diagnosed with a brain tumor. As a tumor grows in the brain, it places increased pressure on surrounding tissue and destroys healthy brain cells, which can cause cognitive and emotional changes. It is estimated that approximately 50 to 80 percent of people diagnosed with a brain tumor experience changes in cognition and behavior at the time of diagnosis. The size, type and location of the tumor all play a role in determining whether a person will experience cognitive problems and what form they will take.
Chemotherapy — chemotherapy is used to treat a wide range of cancers and has been shown to be effective in killing cancer cells; however, chemotherapy can also damage healthy cells. The type of cognitive changes a person may experience varies with the type and dose of chemotherapy, how long treatment lasts and whether it is combined with other forms of treatment. It is estimated that at least 30 percent of women who receive chemotherapy to treat breast cancer experience cognitive changes during and, in some cases, for some time after chemotherapy. Chemotherapy for other types of cancers can also affect cognition. The effect of chemotherapy on the brain is sometimes referred to as “chemobrain,” “chemohead” or “chemofog.”
Radiation therapy to the brain — radiation therapy may be used when surgery is not possible, for tumors that cannot be completely removed, or after surgery to prevent or delay the tumor from recurring. While radiation to the brain can kill cancer cells, it can also damage healthy tissue near the tumor. Some patients who undergo brain radiation develop cognitive symptoms. The extent and degree of cognitive change depends on how much surrounding healthy tissue is damaged from the radiation.
Brain Surgery — brain surgery is performed to remove cancerous cells or tumors from the brain. In some cases, removal or partial removal of a brain tumor can lead to improvements in cognition by lowering the pressure exerted on the brain by the tumor and reducing brain swelling. Brain surgery can also cause declines in cognition due to removal of healthy tissue when removing the tumor. The level of cognitive change depends on the amount of damage to surrounding healthy tissue during surgery.
Certain medications used to treat symptoms associated with cancer.
Medical complications such as seizures, anemia and endocrine dysfunction.
Psychological distress associated with having cancer and undergoing cancer treatments.
Physical symptoms such as fatigue and pain.

Cognitive and other changes are often subtle, and not all patients will experience these problems. For those who do, cognitive problems may range from mild to severe, and they may be temporary or persist long after treatment has ended. Cognitive changes can happen suddenly, or they can develop slowly over time.

Cognitive changes can affect many parts of a person’s life, such as the ability to work, socialize or do everyday tasks. The sooner cognitive changes are discovered, the sooner steps can be taken to treat the problems and optimize a person’s cognitive function and quality of life.

Neuro-Oncology Cognitive Clinic

The Neuro-Oncology Cognitive Clinic at Froedtert & The Medical College of Wisconsin specializes in helping cancer patients cope with cognitive, behavioral and emotional changes that may be caused by their disease and/or treatment. The clinic is unique in the region.

Medical College of Wisconsin neuropsychologist David Sabsevitz, PhD, sees patients in the clinic. Dr. Sabsevitz specializes in evaluating adults with neurological, behavioral and developmental disorders. He works with Medical College of Wisconsin physicians and staff in medical oncology, radiation oncology, neuro-oncology and neurosurgery, and with each patient’s referring physician to coordinate care.

In the clinic, Dr. Sabsevitz:

Conducts comprehensive neuropsychological evaluations to characterize what effect a patient’s cancer has had on cognitive and emotional functioning
Evaluates patients very early on in their illness (shortly after diagnosis but before treatment starts) to establish a cognitive and emotional baseline
Conducts follow-up testing on regular intervals, which are then compared to the initial baseline evaluation to monitor for cancer and/or treatment related changes in cognition
Assists in developing a treatment plan for cognitive, emotional and behavioral problems
Assists patients in returning to work or, if necessary, filing disability claims, obtaining academic and/or vocational accommodations, determining what type and how much supervision is needed to ensure a patient’s safety and help secure rehabilitation services.

Early Evaluation Important

It’s important for people who are diagnosed with a brain tumor to have their cognitive skills evaluated at the time of diagnosis. By the time a tumor is found, it may have already affected cognition. Treatment may also cause cognitive changes. Therefore, an initial evaluation can measure the person’s current cognitive level, and follow-up testing can show any changes that may occur following treatment.

For people who will begin chemotherapy, or who will receive radiation therapy to the brain, cognitive tests should ideally be conducted before treatment begins. The initial tests create a baseline against which changes can be measured. Regular follow-up testing will show if any cognitive, emotional or behavioral changes have occurred since the previous tests. If changes are found, various treatment options can be used to optimize the person’s cognitive function and quality of life.

If a cognitive evaluation is not possible before treatment starts, Dr. Sabsevitz can still conduct cognitive testing for patients and develop a treatment program if testing shows changes that can be treated.

Patients may be referred to the Neuro-Oncology Cognitive Clinic by a physician, or they may contact the clinic by using our online form or by calling Froedtert & The Medical College of Wisconsin at 414-805-3666 or 800-272-3666.

Author: Marla Fraunfelder