Exploring Cognitive Function Research for Cancer Survivorship With Diane Von Ah, PhD, RN, FAAN
At the recent 47th Annual Oncology Nursing Society (ONS) Congress in Anaheim, California, Dr. Diane Von Ah, Distinguished Professor of Cancer Research at The Ohio State University College of Nursing, gave a presentation about the current state of research regarding cognitive impairment and functional limitation among cancer patients and survivors. In this interview, Dr. Von Ah further expands on her research in this field and explains the role of nurses in improving patients' quality of life both during and after treatment.
Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, I'm here with Dr. Diane Von Ah to discuss her recent presentation at ONS Congress. To start us off, would you like to give us an overview of symptom science and what its current state of research is?
Diane Von Ah, PhD, RN, FAAN: Symptom science is really a broad term. When we look at symptom science as clinicians and as nurses, we trying to identify the symptoms that are important to our cancer patients. We're working towards identifying those symptoms and being able to predict who will have them, identifying the underlying mechanisms that might be cause some of these symptoms for our patients, and, most importantly, working with our patients to try to address them and manage them better. How can we treat the individual patients with the concerns that they have?
Oncology Data Advisor: Thank you. What is the impact of cognitive impairment on functional limitation, work ability, and quality of life among patients with cancer?
Dr. Von Ah: That's a great question. I've worked with patients for a long time now, and some of their major concerns have been in relationship to their cognitive impairment or cognitive dysfunction. In the beginning, for most of these patients, it is attributed to concerns in relationship to chemotherapy. But as we've worked with patients more and more, we understand that even patients coming into treatment can have cognitive concerns, whether that's in relationship to the cancer or the stress related to cancer, but these concerns that these patients have are very valid. We've worked really hard to document what those concerns are and what the impact may be on their everyday life.
What my research has shown is that those patients with cognitive concerns experience a greater impact on their functional ability, their quality of life, and their work. I've interviewed patients about this impact on work, and I've conducted quantitative studies with patients. What we've seen are concerns in relationship to their ability to manage time and their ability to process the information in a speedy way, what we call speed of processing. They say to us, "I was able to do so many things and multitask, and now I have to really focus to just accomplish a task that didn't take me a very long time to do before."
It's not that they aren't being completely functional, it's just that they're completely aware that these concerns are impacting their productivity and their ability to manage their time. This has quality-of-life implications to it because for many patients, work is a sign of recovery. It's a time where you should be through the treatment and you should be back to your normal everyday life, and when those things don't happen, then it's really a concerning time for patients. They're in survivorship and they're not being seen regularly in the clinics, so it's really a time where I think we could intervene and provide opportunities to help patients move back into their normal everyday functional ability.
Oncology Data Advisor: How can technology aid in personalized symptom intervention?
Dr. Von Ah: Oh, I think technology is going to continue to advance and to enhance what we're able to do. The work that I have been doing recently is working with a company called Posit Science in relationship to their Brain HQ Program. It's a cognitive training program in which patients or participants can work through and exercise their brain. Much like what we hear about exercise for our physical well-being, these are exercises for the brain using neuroplasticity and building new tracks and new connections. Hopefully, over time, that's going to provide some advantage for those patients.
There are also other opportunities that we have with technology to try to enhance patients' everyday life. Many patients will use reminder cues, or GPS location tools. There are many things that we can use in our everyday life to help make it easier. I think the industry is going to continue to develop those kinds of things, especially to address the cognitive concerns that cancer patients have, and that other individuals, as we age, may have as well. I see a lot of things on the horizon with virtual reality, avatars, and in-home opportunities. That's really going to be a growing field to keep people as independent as possible for the future.
Oncology Data Advisor: Great, thank you. That's very exciting to hear about all that. What are the future directions of symptom science and cognitive impairment research?
Dr. Von Ah: For the symptom science portion of it, there's a lot of understanding that some of these symptoms are correlated. Most of the times, patients don't just present with one individual symptom. The more we understand about underlying mechanisms and understand who may be at risk—that's a really important area, as to who may be more at risk for symptoms and what symptoms are related to specific treatments—the better we're able to understand those underlying mechanisms and the better we'll be able to treat these symptoms. I think that there's going to be an approach to trying to treat a larger subset of symptoms together, symptoms that often cluster together, causing patients to have multiple symptoms. There may be an underlying mechanism. If we could identify what that is, we would treat it more effectively, and that may have benefit on other symptoms.
As far as improving quality of life, patients who have symptoms may report them, but it's when the symptoms interfere with everyday life that it really comes to the level where they seek treatment. As we broaden and improve our cancer treatments, we're going to need to broaden our tools in order to help patients manage symptoms—not only in the acute phase, but in late and long-term effects, as well. As new innovations are being developed to treat cancers, patients are living longer; but that means they're living longer with these symptoms, and we really need more tools to address correlated symptoms or symptom clusters.
Nurses are at the forefront to identify our patients' needs, to really listen and find out what's important to them, and to understand how we may then be able to improve not only their symptoms but also their quality of life. Cancer affects so many parts of our patients. It affects their loved ones; it's not just isolated to the patient, but it actually impacts the entire family. I think nurses are actually at the forefront to take the lead in studying symptom science and addressing these symptoms for our patients. That would be my hope for the future, that we continue to focus on what our patients' needs are and what their concerns are, because cancer really does impact their functional ability and their quality of life. I think nurses are in a prime position to be able to address these needs.
Oncology Data Advisor: Thank you so much for that really great overview.
Dr. Von Ah: You're welcome.
About Dr. Von Ah
Diane Von Ah, PhD, RN, FAAN, is a Distinguished Professor of Cancer Research at The Ohio State University College of Nursing. Her research focuses on symptom management during cancer survivorship, including interventions for cognitive dysfunction in breast cancer survivors. Dr. Von Ah serves on the National Cancer Institute/Physician Data Query (NCI-PDQ) Supportive and Palliative Care Editorial Board and has served on the National Academies of Science, Engineering, and Medicine committee for providing recommendations to the Social Security Administration regarding cognitive impairment and functional ability in survivors of cancer.
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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.