NP: Lecture 7 Cancer

Question 1

prevalence cancer

Answer 1

1/3

Question 2

survival has increased with … since 1970

Answer 2

doubled

Question 3

but… more of us beat cancer

Answer 3

oke

Question 4

why are more people getting cancer

Answer 4

live longer, cancer increases with age

Question 5

cognitive impairments occur in these patients

Answer 5

primary brain tumors
brain metastases
cancer outside CNS

dus basically allemaal

door cancer en treatment!

Question 6

prevalence primary brain tumors

Answer 6

2%

Question 7

brain metastases prevalence

Answer 7

30%

Question 8

incidence of cognitive impairment

Answer 8

75% in cns disease
30% in non cns disease

Question 9

hoeveel van malignant tumors is glioma

Answer 9

80%

Question 10

high grade glioma

Answer 10

bad expectations, most of the patients helaas.

Question 11

low grade glioma

Answer 11

astrocytoma, oligodendrogliomas

= betere prognosis, maar helaas developen veel ook naar high grade

Question 12

primary brain tumors in nl

Answer 12

1200 pt per jaar nieuw

Question 13

secondary brain tumors prevalence

Answer 13

30% van alle brain tumors!

Question 14

causes of cognitive impairment in cns en non cns

Answer 14

beiden hetzelfde:

cancer
treatment
fatigue
distress

Question 15

want kanker kan leiden tot cogn. impairment?

Answer 15

ja, door molecular characteristics -> IDH1-WT tumors meer cognitive dysfunction door aggressive growth which preclutes compensatory brain reorganisation

Question 16

brain cancer treatment options

Answer 16

balance between tumor control and toxicity

surgery
radiotherapy
chemotherapy
immunotherapy

Question 17

Cure is limited, survival varies between months up to several years. Important to focus on quality of life, including cognition

Answer 17

oke

Question 18

radiation on cognition

Answer 18

Very early subtle forms of radiation-induced damage drive chronic processes that can lead to cognitive impairment

Question 19

hoe kan het dat radiotherapie een effect heeft op cognition

Answer 19

decline oligodendrocytes
microvascular damage
subtle loss of white matter integrity (demyelination, necrosis)
neuroinflammation
gliosis

Question 20

Worsened memory in
patients with response suggests
WBRT has an adverse effect on
memory, likely due to adverse
effect on hippocampal circuitry

Answer 20

oke

Question 21

NKA initiative obv resultaten cog. impairment

Answer 21

Brain tumor pts undergoing brain irradiation receive a neuropsychological examination and an extensive MRI of the brain pre- and post radiotherapy

Question 22

risk factors for cogn. decline

Answer 22

dosage, volume therapy, combination with chemo, age (jonger dan 5, older than 60), vascular risk factors

Question 23

intervention against cognitive decline

Answer 23

• De-escalation of treatment
• Technical interventions
• Pharmacological interventions
• Behavioral / life style interventions: Cognitive rehabilitation, Brain training, Exercise. aim: to use strategies to compensate for and cope with cognitive impairments.

Question 24

2 soorten strategy training

Answer 24

• External compensatory strategies (electronic
  organizers, to-do-lists etc)
• Internal memory strategies: re-teaching the brain to
  retain information using different mental strategies

Question 25

• Cognitive dysfunction is influenced by tumor location, tumor genetics, and treatment
• Radiation (but also chemotherapy and immunotherapy) can adversely impact brain
  structure, brain function, and ultimately cognitive function
• Treatment benefit is a combination of survival (disease control) AND how a patient
  feels/function
• Subgroups of patients are at increased risk: Identification of risk/protective factors
  would permit consideration of risk adjusted therapy
• Therapeutic approaches to prevent cognitive decline and restore cognitive function
  are of substantial importance

Answer 25

oke

Question 26

meest voorkomende kanker

Answer 26

huid

Question 27

non-cns tumor treatment

Answer 27

• Surgery
• Radiotherapy
• Chemotherapy
• Hormonal therapy
• Targeted agents/immunotherapy

Question 28

chemo therapy

Answer 28

attacks rapidly dividing cells

Question 29

targeted therapy

Answer 29

targets proteins required for cancer growth

Question 30

immunotherapy

Answer 30

uses our immune system against cancer

Question 31

bij hoeveel mensen in totaal cognitive decline door treatment

Answer 31

ongeveer 30% van alle cancer patients

Question 32

even 20 years after treatment: cognitive decline tov. controls without cancer

Answer 32

age effect of 6 years

Question 33

damage of chemo

Answer 33

neuroinflammation, decline in oligodendrocytes and new neuron generation
in the hippocampus, altered function of adult neurons, vascular damage

Question 34

dus general effects of chemo

Answer 34

grey matter decline in volume
white matter decline in integrity
changes in connectivity

Question 35

2 interventions voor cognitive dysfunctions

Answer 35

pharmalogical or behavioural/life style (cognitive rehabilitation, exercise)

Question 36

• Non-CNS cancer therapy is associated with cognitive dysfunction
• Treatment related cognitive decline has been observed in 30% of patients
• Growing population of cancer survivors with cognitive deficits
• CT: Learning and memory, executive function, and processing speed
• Comorbid with affective distress, but independent of distress
• Persistent cognitive dysfunction in a subset
• Structural and functional brain changes observed both acutely and persistently
• Clinical observations have been supported by preclinical experiments
• Further our understanding of mechanisms
• Allow us to develop biologically based interventions

Answer 36

oke

Question 37

chemotherapy and distress

Answer 37

cognitive impairment is comorbid with distress, but independent of distress!!!

Question 38

wat voor effect heeft chemo nog een keer

Answer 38

learning
memory
executive function
processing speed