Neuroscience

Israeli researchers offer new hope for cancer survivors suffering from side effects of treatment

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Emil and and the author, Shelley A. Sackett, shortly before Emil’s death in 2019 at the age of 82. 

By Shelley A. Sackett

 

When Emil and Lili Berkovits moved to Boynton Beach, Florida, from Salem, Massachusetts, in 2014, they were excited to start their retirement after Emil’s long career as a cantor.

A fifth-generation hazzan who had emigrated from Czechoslovakia as a young child following World War II and grown up in Montreal, Berkovits spent most of his professional career in the United States.

He was a well-built, physically active man who played baseball professionally, but after an injury he gave it up for a career in musical and communal leadership. Berkovits helped bring generations of boys and girls to their bar and bat mitzvahs and made music that stirred the souls of many a congregant.

Decades later, after retiring to Florida, Berkovits, then 78, developed a persistent sore throat and noticed a lump on his neck. He soon was diagnosed with cancer of the oropharynx, near the back of his throat. Oropharyngeal cancer can be slow growing and, like many cancers, often spreads before any symptoms appear. By the time the cancer is detected it can be quite advanced.

The treatment was grueling. Over seven weeks, Berkovits received 35 radiation and seven chemotherapy treatments. He developed a heart infection and his throat became so inflamed that he couldn’t eat — both results of the radiation, doctors told him.

But the treatment was effective: For five years, well into his 80s, Berkovits lived cancer-free.

Yet he suffered dearly from the consequences of the treatment. He no longer could produce saliva, leaving his mouth permanently dry. He lost most of his ability to taste. He went on an exclusively liquid diet because regular food could cause him to choke. He lost 25 pounds, leaving him physically weak.

“Because he can’t eat normal food, he has no energy,” his wife, Lili, said earlier this year, shortly before Berkovits’ death over the summer. “Nothing can help these eating and swallowing issues.”

Berkovits’ experience was not unusual. Many cancer survivors find themselves struggling with health issues related to their treatment for years after they are declared cancer-free. Problems may include pain, fertility issues, infections, memory problems, sexual health issues, cognitive impairments and more, including increased risk of secondary cancers. For many, the health problems last a lifetime.

In Israel, a growing cadre of cancer researchers is focusing not just on cancer treatments but on improving life for cancer survivors by trying to mitigate treatment side effects.

“Quality of life is a subject of utmost importance as cancer patients go through therapy, and even once they complete their treatment,” said Dr. Mark Israel, national executive director of the Israel Cancer Research Fund, or ICRF. “It is not enough to cure cancer. We must also address the patients themselves and their experience.”

ICRF is now investing in research that aims to offset the debilitating side effects of cancer treatments that linger even after the disease is eradicated.

At the Rambam Health Care Campus in Haifa, its director of oncology, Dr. Irit Ben-Aharon, is studying how chemotherapy damages blood vessels, which can lead to vascular disease and fertility problems. By helping cancer patients avoid these toxic effects of their treatment, doctors can reduce their risk of developing cardiovascular disease or infertility in the future.

Ben-Aharon is hopeful her work will be of special benefit to younger cancer survivors.

“As the incidence of cancer in younger individuals is increasing, survivors with very long life expectancy are emerging as a group with significant challenges related to treatment,” she said.

Ben-Aharon’s work is one of four research projects currently funded by ICRF focused on improving the lives of cancer survivors. Two of the projects are being supported by grants provided through the Brause Family Initiative for Quality of Life at ICRF.

Since its founding in 1975, ICRF has raised more than $72 million for Israeli cancer research, including groundbreaking work that has led to both treatment breakthroughs and improved treatment outcomes.

While cancer treatments such as chemotherapy, radiation therapy to the brain and immunotherapy are crucial for curing cancer, they may leave the patient with cognitive deficits. Up to 75 percent of cancer survivors suffer cognitive impairments, including problems with attention, memory and learning.

Dr. Yafit Gilboa, an occupational therapist at The Hebrew University of Jerusalem’s Department of Medicine, is using her ICRF grant funded by the Brause Family Initiative to explore a novel approach to ameliorating that cognitive decline. This new approach, tele-rehabilitation, provides for the remote delivery of courses designed to diminish the cognitive effects of cancer therapy.

Gilboa’s strategy for treating patients with cancer-related cognitive impairment is comprised of 30-minute cognitive trainings several times a week using their home computer, supplemented by a weekly videoconference session with an occupational therapist.

Gilboa credits the Israel Cancer Research Fund for supporting not just research for cancer treatments, but also for treatment of side effects.

“This research makes a valuable difference in the quality of life for cancer survivors,” Gilboa said.

She and her team at The Hebrew University already have recruited patients from Hadassah Medical Center and completed a pilot study that showed encouraging results in cognitive and occupational performance. Patients also reported decreased depression and anxiety and an increased sense of well-being.

“One patient reported that since starting this therapy, he was striving to live the way he did before he got sick. Another said she felt more self-confident,” Gilboa reported.

Dr. Jacob Hanna of the Department of Molecular Genetics at the Weizmann Institute of Science in Rehovot is focused on pluripotent stem cells, which are like the cells from which babies are formed in that they have the ability to become any type of organ or tissue. Hanna and his team are studying how cells with the properties of embryonic stem cells can be generated from a patient’s skin or hair follicles and then used to create an array of cell types for transplantation into cancer patients. This could be instrumental in helping cancer survivors whose treatment regimen destroyed tissue or damaged organs.

Dr. Avi Priel of The Hebrew University’s School of Pharmacy is working on the problem of chronic pain among cancer survivors. While opioids are the most powerful tools for managing pain, they can have debilitating side effects and may be addictive for those requiring chronic relief.

“In the last two decades, the misuse of opioids — powerful but problematic drugs — has shed light on the need for new, less addictive painkillers with fewer side effects,” Priel said. “This is precisely my lab’s research goal.”

Priel’s research team, another recipient of a grant provided through the Brause Family Initiative, is working to develop novel analgesics — painkillers — that will have a potency similar to opioids but with minimal side effects. The team is also investigating drugs that can be combined with opioids to reduce the frequency and amount of opioid required to achieve good pain control.

“We believe these will enable patients who suffer from cancer pain to enjoy a better quality of life,” Priel said.

PEM hires neuroscientist to enrich visitor experience

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Tedi Asher

Dr. Tedi Asher

Groundbreaking initiative first in the museum world

By Shelley A. Sackett, correspondent

 

By his own admission, Dan Monroe is “afflicted with intense curiosity.” The Peabody Essex Museum executive director and CEO relaxes by intensely investigating fields unrelated to art and appreciation, such as quantum physics.

 

A few years ago, neuroscience caught his attention. After reading roughly 150 books and publications, it became clear to him that neuroscience has a direct role to play at PEM.

 

“What we essentially do is to create experiences of art and culture. We call them exhibitions and programs, but we are really creating experiences,” he said.

 

Since research shows that all experiences are created in our brains, he reasoned, if PEM wanted to remain at the forefront of designing meaningful, relevant and impactful art experiences, it would be a good idea to better understand how brains work.

 

Essentially, he thought that by getting inside visitors’ heads and figuring out how they felt, how they saw, what caught their attention and what they remembered, PEM could enrich their visits.

 

Plus, it would make the museum a more fun experience.

 

His team began experimenting with this new approach, adding innovative multi-sensorial elements to select exhibits. Professional dancers greeted visitors in the “Rodin: Transforming Sculpture” galleries, their movements and poses reflecting those of the sculptural works. “Asia in Amsterdam” showcased fragrant spices, a soundtrack conveying 17-th century Dutch life, storytelling and striking graphics.

 

The feedback was overwhelmingly positive.

 

“The dancers created a new kind of attention and a new avenue for people to appreciate and see sculpture,” he said, noting that the traditional way museums transmit information — through written labels — is not working. “If people read them at all, they spend an average of 2.5 seconds, even at the oversized introductory panels,” he said. He wanted a more transformative experience for the PEM guest and, based on visitor surveys, so did the public.

 

After the success of the Rodin and Asia shows, Monroe and his team decided to expand their reach. They applied for and received a $130,000 grant from the Barr Foundation, a Boston-based philanthropic organization, to launch the neuroscience initiative and delve deeper into using neuroscience research to enhance the way PEM designs exhibits.

 

The initiative enabled PEM to hire Dr. Tedi Asher, a neuroscientist who earned her Ph.D. from Harvard Medical School’s Biological and Biomedical Sciences program 2016, and joined PEM as its full-time Neuroscience Researcher in April. “To our knowledge, this is the first art museum in the world to hire a neuroscientist and put them on staff,” Monroe said.

 

Asher is thrilled with her first job outside the academic arena. “Where else but at art museums can one witness such breadth and depth of emotional experience?” she asked.

 

She was looking for a position that would allow her to creatively communicate neuroscience to non-scientists in a non-traditional teaching environment that would reach beyond academia and benefit the public at large.

 

“I came across PEM’s job ad and it seemed to fit that bill,” she said.

 

Asher’s primary academic focus has been studying emotion, starting as an undergraduate at Swarthmore College, where she studied learning and memory in the common fruit fly. Her doctoral work in neuroscience investigated aggressive behavior in mice.

 

At PEM, she will step out of the laboratory and explore how PEM can enhance and enrich the visitor experience by designing exhibits that will evoke human emotions, thereby leaving lasting impressions.

 

“Teri has a keen interest in using neuroscience to make the world a better place. She’s learning a great deal about art and culture and how museums work at the same time she’s teaching us about neuroscience and how brains work,” Monroe said.

 

Asher’s tasks are threefold. She will investigate how human brains are wired to appreciate art and how that information can be used to design exhibits that resonate on a personal level. She will then work with PEM staff, teaching them basic concepts that are relevant to their work as exhibition and program designers, such as how visual and attention systems work and how they relate to emotion. Finally, she will also pen a small publication to explain the concept behind the neuroscience initiative and its applicability to museums.

 

The skills she honed during schooling — particularly her ability to “mine the literature in an efficient and effective way” — will be key to her position. Specifically, she will be looking at the structure of the visual system and how that influences visual perception, asking questions such as, “What neurostructures allow us to regulate attention? What characterizes how we allocate attention with an experience like a museum visit?”

 

It will be then be up to PEM exhibit designers and staff to translate and incorporate that information into the museum’s installations.

 

The timing of Asher’s hire couldn’t be more perfect. PEM continues to undergo a comprehensive renovation and expansion project, featuring a 40,000 square-foot new wing of galleries, which will open in 2019. At the same time, Monroe explained, PEM is also in the process of refreshing its permanent collections, creating new installations of virtually all of them.

 

“The entire experience at PEM will be new, based on ideas we’re deriving from neuroscience and other fields,” he said. Asher will assist in this overhaul too.

 

Since 2003, PEM has used The Morey Group to measure overall visitor satisfaction through a standardized survey tool used within the museum industry. Among the 80 museums tracked by Morey, PEM is head and shoulders above the rest, ranking number one every year since 2003.

 

“We’ve long been pursuing innovative approaches,” Monroe explained modestly, adding, “but the neuroscience initiative is a distinctive one.”

 

Monroe credits the neuroscience initiative with motivating PEM to shift gears away from written text and towards better and more storytelling. “Stories are the glue that holds us together as social animals. Good stories elicit emotion and emotion is really critical,” he said.