Doctorate in Clinical Psychology, University of Southern Mississippi
APA Clinical Internship in Medical Psychology, Duke University Medical Center
Postdoctoral Fellowship in Clinical Neuropsychology, Duke University Medical Center
Date Joined The Preston Robert Tisch Brain Tumor Center at Duke:
Why Quality of Life Research is Important:
When a patient is diagnosed with a brain tumor, his or her life will never be the same. Whether a highly malignant tumor or a low-grade tumor, whether the patient has surgical resection, radiation therapy, chemotherapy, or other type of treatment, he or she has been irrevocably changed by the diagnosis and the effect it has on his or her life. We cannot yet promise survival for these patients; despite remarkable advancements in diagnosis and treatment, brain tumors frequently take the lives of their victims. What we can hope to do, however, is make living with a brain tumor less devastating. By recognizing the negative impact brain tumors have on quality of life, by educating patients/caregivers about what to expect and how to cope, and by offering new treatments to decrease these negative consequences, we can reduce the drain that this diagnosis has on quality of life.
Because the brain is the center of intellectual functioning and personality, brain tumors can impair patients’ cognitive abilities and alter the way they behave or express emotion. Frequently, we see brain tumor patients who maintain fairly strong and healthy bodies, but who feel they have lost their sense of self, their identity, their worth.
I was particularly moved by a young woman with a glioblastoma multiforme who was diagnosed two weeks before she was to complete her residency in medicine. This brilliant woman had worked incredibly hard to complete medical school and a grueling residency program, and just as she was about to enjoy being a physician, she is told her life expectancy is less than one year. When many of us would choose to take to our beds and grieve or take a long delayed exotic vacation as a last wish, this woman made it clear she was going to practice as a doctor just as she had planned to do.
But her cognitive speed of processing was slowed and her short-term memory was not what it once had been. I was not sure she was being realistic in planning to take care of patients, but she asked for my help and I joined with her to try to make her dream come true. We started her on medications aimed at improving her cognitive abilities and to give her increased energy during her radiotherapy and chemotherapy. These drugs helped her significantly and much to my surprise, she went to work as a family practitioner in a small practice in her hometown. She worked closely with the other physicians in the group to make sure she was closely monitored to avoid costly mistakes, and she was very responsible in resting or not seeing patients when she had a bad day. When I spoke with one of the senior doctors in her practice about nine months into her work, he told me she was one of the most competent and conscientious young physicians he had ever known.
This woman practiced for 11 months before her tumor recurred. When she had recurrence, her cognition became worse and she knew that she had to give up her career as a physician. When I next met with her, I thought she would be devastated at the loss of her career and the very real possibility that her death was near. She was not. She squeezed my hand from her wheelchair and thanked me for helping her “think better” so she could be a “good doctor.” I was astonished and suggested that it had all been in vain since she was now clearly going to lose her battle to stay alive. This woman shook her head and patted my hand and said that she would not trade her 11 months as a doctor for 50 years of healthy living without being a doctor. In my opinion, that is quality of life personified, and that is why I come to work each day.
I completed a pilot study using donepezil, an Alzheimer’s drug, to improve short-term memory dysfunction in brain tumor patients. The results showed clear trends toward efficacy, and the manuscript has been submitted for publication so that further research can be conducted with this and similar medications.
I just completed data collection evaluating adult brain tumor patients for comorbid psychiatric disorders. This data will be analyzed and the results will be used to plan future intervention studies to improve the psychological distress in brain tumor patients.
I also conduct serial neuropsychological assessments and frequent surveys of patient quality of life in conjunction with many of our clinical trials. The goal is to preserve cognitive functioning and reduce psychological stressors in brain tumor patients undergoing treatment with experimental therapies.
I will continue to try to develop interventions that will improve cognitive functioning and reduce psychological distress in brain tumor patients. I believe that through pharmacological and behavioral modalities, we can reduce the negative impact brain tumors have on patients’ quality of life. I hope that we can continue to develop more and more effective therapies to successfully treat brain tumors while at the same time reducing the negative effects these therapies can have on cognition, mood, and personality. Until we can help brain tumor patients live longer, my goal is to at least help them live better.