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Cognitive functioning and quality of life

In patients with intracranial tumors, there are three main factors that should be included in the evaluation of cognitive functioning and quality of life.
  • Type of tumor
  • Size
  • Location

After an operation for a brain tumor, the patient's need for follow-up varies. It is recommended that the patients receive an offer of follow-up at least 3 and 12 months after the operation in order to detect any future changes. The focus should then be on changes from previous functioning (before the tumor took effect) and on all areas that can influence their quality of life. Conversations should include questions about cognitive and psychic changes, since patients often do not report this spontaneously.

The patients should be offered neuropsychological evaluation before they return to work. This is in order to confirm or disprove the basis for concern about cognitive changes. A number of patients experience more cognitive changes than can be measured objectively, and it can therefore be comforting to be told that they have good cognitive preconditions. It is a known problem that patients with brain tumors experience neuropsychological attacks (1–3).

Psychological changes and problems sleeping.

Many patients report psychological changes and problems sleeping. In a focus-group study carried out at Rikshospitalet in 2007 on patients with oligodendroglioma (article not completed), the patients reported symptoms of anxiety, depression, grief, pain, epilepsy and reduced energy. Many patients also find that there are stigmas attached to brain tumors among the general public. The symptoms depend on where the tumor is located, the supplementary treatment they have received (radiation and chemotherapy), and social and relational factors, in addition to the patient's level of functioning at the start of the disease.

Posttraumatic stress syndrome.

A small number of patients develop posttraumatic stress disorder after brain surgery (3). ”To be diagnosed with a life-threatening illness" is given as an example of traumatic stress (4) in DSM-IV. Patients can also display personality changes as a consequence of a tumor and/or surgery. This applies especially if the tumors occur frontally. The personality changes are reported best by relatives (5).

It is important that changes to cognitive and psychological/psychiatric functions are given equal attention as any motor or sensory effects, because they will, to a major extent, negatively influence the patient's quality of life. 

It is recommenced that a team is set up locally with neurologists, oncologists, neuropsychologists, psychiatrists, medical-social workers and oncological nurses in order to follow up on patients with brain tumors. 

Current methods of intervention in relation to adapting to a new life situation.

Psycho-social interventions and interventions directed at behavior have been shown to be generally useful for patients after cancer treatment (6).

Among individually targeted therapies, cognitive behavior therapy is frequently used (7). Group therapy has also shown itself to be useful after cancer treatment and this is well documented in the book "Group Therapy for Cancer Patients". Family therapy and interviews with the most affected family members is recommended, especially if there are personality changes or if the family have requested this.  

References

  1. Fox SW, Michell SA, Booth-Jones M. Cognitive impairment in patients with brain tumors:  assessment and intervention in the clinic setting. Clinical Journal of Oncology Nursing, 2006, April; 10 (2):  169-76.
  2. Rønning C, Sundet K, Due-Tønnessen B, Lundar T, Helseth E. Persistent Cognitive Dysfunction Secondary to Cerebellar Injury in Patients Treated for Posterior Fossa Tumors in Childhood. Pediatric Neurosurgery (2005) 41:  15-21.
  3. Rønning C. Posttraumatisk stresslidelse etter nødvendig hjernekirurgi. Page 143-150 in the book:  Pasienten og sykdommen – psykiske faktorer ved somatisk sykdom. Edited by:  Hem, Erlend; Vaglum, Per; Fyrand, Live; Nerdrum, Per. Gyldendal Akademiske, June 2007.
  4. Tedstone JE, Tarrier N. Posttraumatic stress disorder following medical illness and treatment. Clinical Psychology Review; 23 (2003) 409-448.
  5. Rønning C, Finset A, Helseth E. When the personality changes. Tidsskrift for Norsk legeforening, no.17, 2007; 127 s. 2246-2247.
  6. Fekete EM, Antoni MH, Schneiderman N. Psychosocial and behavioral interventions for chronic medical conditions. Current Opinion in Psychiatry (2007) Vol 20 (2), p 152-157.
  7. Giessen MFM, Verhagen CAHHVM, Bleijenberg G. Cognitive behavior therapy for fatigued cancer survivors:  long term follow-up. British Journal of Cancer (2007) 97, 612-618.
  8. Spiegel D, Classen C. Group Therapy for Cancer Patients. A Research-based Handbook of Psychosocial Care. Basic Books 2000.

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