Managing Your Mental Health During Treatment
- ‘Antique Roadshow’ star Theo Burrell, who is living with brain cancer, admits she is still coping with the symptoms and side effects from grade 4 glioblastoma (GBM), an aggressive form of brain cancer.
- Burrell says ongoing treatment is taking a toll on her mental health because she knows she’ll likely live with the aggressive brain tumor for the rest of her life.
- Research published in Epidemiology and Psychiatric Sciences found that “35 to 40 percent of cancer patients have a diagnosable psychiatric disorder,” and the number of people experiencing mental health challenges is “higher among cancer patients with advanced stages of cancer and in palliative care settings.”
- Burrell has already undergone surgery, radiation, and chemotherapy for treatments. She receives regular scans to monitor her progress; her latest scans were deemed “good.”
- Glioblastomas grow and spread very quickly. Patients typically have an average survival rate of 15 months with treatment and less than six if left untreated.
“With the physical battles come the mental struggles, and although I’m very relieved my last scan was looking good, the knowledge that having a brain tumor is forever is hard to accept at times,” Burrell said in an Instagram post about her condition.
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“The fatigue from the chemo has really flattened me over the last couple of weeks, with regular headaches rearing their ugly heads,” Burrell said.
Burrell is receiving the chemotherapy drug temozolomide, which is the most common chemotherapy used for higher-grade gliomas.
When it comes to temozolomide, the most common side effects include:
- Nausea
- Constipation
- Fatigue
- Hematologic toxicities
WATCH: Choosing the right chemotherapy for glioma patients.
“In terms of managing side effects, the standard approach is to use an anti-nausea drug, often Zofran, before the patient takes the chemotherapy every night — and then, as needed,” Dr. Howard Colman, a neuro-oncologist at the Huntsman Cancer Institute at the University of Utah told SurvivorNet.
Other interventions to manage side effects might include medication to help with constipation, stimulants to help with fatigue, and adjusting or stopping treatment if blood counts drop too low.
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Burrell, a devoted mother, acknowledges the profound mental toll of her battle with cancer. Coping with a diagnosis is not a linear process—it can take weeks, months, or even years to fully navigate. The journey comes with highs and lows, and it’s vital to recognize that. Whether leaning on loved ones or seeking guidance from a mental health professional, support can provide strength and resilience in even the toughest moments.
Helping Patients With Brain Cancer
Coping With Your Mental Health After a Diagnosis
According to Mental Health America, “56% of adults with a mental illness receive no treatment, and over 27 million individuals experiencing a mental illness are going untreated.”
While millions of people have unmet mental health needs, the need for mental health resources is even greater among cancer patients and their families.
Research published in Epidemiology and Psychiatric Sciences found that “35 to 40 percent of cancer patients have a diagnosable psychiatric disorder,” and the number of people experiencing mental health challenges is “higher among cancer patients with advanced stages of cancer and in palliative care settings.”
WATCH: How Genetic Testing Can Help Determine the Right Form of Mental Health Treatment.
Dr. Asher Aladjem, a board-certified psychiatrist at NYU Langone, tells SurvivorNet, “Anxiety is a protective and normal kind of symptom.”
“Sometimes the anxiety gets to the point that things stand in the way of the scan or whatever the test is, and people avoid it and run away from it. Treating the anxiety allows for the completion of the workup or the treatment or whatever the situation may be in a much more effective way,” Dr. Aladjem said.
Dr. Alagjem encourages patients to advocate for their mental health. He reminds us that even if mental health services are not offered while undergoing physical treatment for a diagnosis, patients can still ask their care team about them.
“We are trying to advocate for patients to be able to get the services that they need with whatever support they may need – whether it’s medications or therapy or nursing staff,” Dr. Alagjem added.
Glioblastoma Diagnosis and Symptoms
Diagnosing gliomas involves a multi-step approach that involves clinical assessment, imaging studies, histopathological examination, and molecular testing.
As patients are diagnosed, they’re observed for typical glioma symptoms. These may include:
- Headaches
- Seizures
- Cognitive or Behavior Changes
- Visual or Speech Changes and Impairments
- Loss of Body Weight and Deconditioning
- Changes in mental function, mood, or personality
- Changes in speech
- Sensory changes in hearing, smell, and sight
- Loss of balance
- Changes in your pulse and breathing rate
During the clinical assessment, the physician will take a detailed history, focusing on the onset and progression of symptoms. Since gliomas can present with non-specific symptoms that overlap with other neurological conditions, ruling out conditions like stroke, infections, or inflammatory disorders is essential during the initial clinical evaluation.
Patients then undergo a neurological exam that tests cranial nerve function, motor strength and coordination, sensory function, and cognitive abilities.
Next, patients undergo an MRI, which provides doctors with a visualization of the tumor.
“If you’re suspected of having a tumor on imaging and our neurosurgeons think that tumor can come out, they will take a piece of that tumor out first and confirm in the operating room and with our pathologists that, in fact, what they are looking at is a tumor,” Dr. Alexandra Miller, Director of the Neuro-Oncologist Division at NYU Langone Health, tells SurvivorNet. “And if it is, they resect it at that time. It’s not usually a two-step procedure.”
If surgery cannot be performed due to tumor location or patient-specific factors, a less invasive stereotactic biopsy can be obtained. Once the tissue sample is obtained, it’s examined under a microscope for molecular testing. At this stage, the tumor is given a grade, which determines how aggressive it is.
WATCH: Molecular testing for glioma patients
- Grade I-II gliomas – These are considered low-grade and tend to grow slowly. “The grade one is a very indolent, benign tumor that can be cured with surgery alone,” Dr. Henry Friedman, Deputy Director of the Preston Robert Tisch Brain Tumor Center at Duke, tells SurvivorNet.
- Grade III gliomas—These are considered high-grade and tend to grow more rapidly. They are typically classified as malignant and require more aggressive treatment, which can include surgery, radiation, and chemotherapy.
- Grade IV gliomas – These are the most aggressive gliomas, which are locally aggressive and require treatment intensification. Glioblastomas are the most common grade IV glioma, “which is by far the most well-known and feared tumor in the lay population and, quite frankly, the medical population,” Dr. Friedman explains.
How Are Gliomas Treated?
Burrell has already undergone surgery to remove her tumor, followed by chemotherapy and radiation, which helped extract the remaining bits of the cancer that surgery could not remove. Specific details of her ongoing treatment remain unclear at this time. However, the route she took early on is typical for glioblastoma treatment.
“The first step is always the neurosurgery. How much can you take out? Is it safe to do surgery? Do you have to rely on a biopsy? Can you even do a biopsy?” Dr. Friedman tells SurvivorNet.
The main treatment options are:
Observation—Some benign, small, and without symptoms of gliomas or tumors located in inoperable locations can be recommended for observation.
Surgery is often the first-line treatment for gliomas, with the goal of achieving maximal safe resection, where the largest amount of tumor is removed without causing significant neurologic deficits. For low-grade gliomas, surgery alone can sometimes be curative.
After surgery, pathologists examine the tumor tissue to understand its features and molecular makeup. This added step helps doctors outline an appropriate treatment.
“We go through a very elaborate process of diagnostics, which includes looking at it under the microscope through our pathology team,” Dr. Friedman explained to SurvivorNet.
WATCH: The Role of Surgery in Treating Gliomas
Radiation and chemotherapy are often needed after surgery because removing the tumor completely is usually not possible due to the tumor’s ability to spread into surrounding brain tissue.
Radiation therapy uses high–energy X–rays to target and kill tumor cells. It is often used after surgery to target residual tumor cells.
Chemotherapy – These medications kill or slow the growth of cancer cells. Chemotherapy can be used alongside radiation or following radiation and is often used in higher-grade tumors.
The Food and Drug Administration (FDA) has approved some drug treatments, including temozolomide (Temodar), to help patients with this aggressive disease. Temozolomide is a chemotherapy drug patients can take after surgery and radiation therapy.
Targeted therapy and immunotherapy are newer treatments designed to target specific genetic mutations in the tumor or to stimulate the immune system to fight the cancer. Their role in the treatment of gliomas is continuing to evolve.
Other FDA-approved drugs for treating glioblastoma include lomustine (Gleostine), intravenous carmustine (Bicnu), carmustine wafer implants, and Avastin (bevacizumab).
Avastin is a targeted drug therapy that blocks glioblastoma cells from requesting new blood vessels that feed and allow the tumor to grow.
The FDA approved Vorasidenib, an IDH inhibitor. It works by blocking the mutated enzyme, slowing tumor growth, and extending the time before disease progression. IDH mutant gliomas tend to grow more slowly and have a better prognosis than IDH wild-type gliomas.
Dr. Alexandra Miller tells SurvivorNet that Vorasidenib is a “huge breakthrough for people with IDH mutant tumors.”
“What I tell my patients is that we have these effective treatments, but what they do is they delay the time to when this tumor comes back. Only in exceptional circumstances would we ever talk about getting rid of one of these cancers a few,” Dr. Daniel Wahl, professor of radiation and oncology at the University of Michigan, tells SurvivorNet.
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