Chemotherapy-brain
Monday, 22 June 2009 20:22
The Abramson Cancer Center of the University of Pennsylvania
Many survivors who have received or are currently undergoing chemotherapy had cognitive changes, often referred to as "chemo-brain." These changes include difficulty with short-term memory, multi-tasking, the levels of learning, reading comprehension, and working with numbers and a decrease in concentration ability. For many years this was attributed by doctors and researchers to depression or anxiety over the diagnosis and treatment of cancer.
More recently, researchers have begun studying and documenting the survivors have cognitive changes after chemotherapy. Although not yet able to determine if only certain chemotherapy drugs are responsible for these cognitive changes.
Those who receive more chemotherapy tend to experience greater problems.
Those who receive more chemotherapy tend to experience greater problems.
Unfortunately, much research has been done regarding "chemo-brain" evaluated a small number of patients. The study of this issue is particularly difficult given the wide variety of treatments and combinations of treatments used to treat different cancer diagnoses. Beyond these differences, patients have different levels of anxiety, depression and support in dealing with the diagnosis, treatment decisions and post-therapy issues. Thus, while patients have reported this phenomenon since the 1970s, it is only recently that physicians and researchers have begun to recognize the effect of treatment on cognition. This attention has led to the formation of a multidisciplinary "International Cognition and Cancer Task Force, whose aim is to address the problems facing cognitive research in cancer survivors.
Although this side effect has been unofficially called "chemo-brain", researchers have found that chemotherapy is not the only culprit. Radiation therapy (particularly involving the brain), biological therapies and hormone therapies have also been implicated. Other health problems and the cancer itself can also help, as the studies above, the probable diagnosis of anxiety plays a role too.
Research has shown that "chemo-brain" between 15-50% of survivors who had received chemotherapy may suffer from impaired attention, concentration, memory (visual and verbal), and processing speed. These may resolve over time, but some survivors can persist for years after therapy.
This may affect a survivor of the ability to perform his job or manage family responsibilities.
Some medicines are being studied as potential treatments for cognitive changes, but not yet enough data to support its use. Some of the agents being studied include: methylphenidate (Ritalin), modafinil (a medication approved to treat narcolepsy), various antidepressants, herbal supplements such as ginkgo biloba or ginseng, and some amino acids. Cognitive rehabilitation programs are structured programs using exercise, tasks that use memory, puzzles, and to "rehabilitate" the mind. These programs are typically used for people with brain injuries, but therapists have tailored programs for cancer survivors.
References and Further Reading
Boivin, MJ et al. Cognitive decline in women newly diagnosed with breast cancer (abstract), American Academy of Neurology's annual meeting in 2008.
Darby, DG et al. The acute cognitive effects of adjuvant chemotherapy in women with breast cancer (abstract), American Academy of Neurology's annual meeting in 2008.
Hede, K. (2008). "Chemobrain is real, but may have new name." J Natl Cancer Inst100 (3): 162-3, 169
Boivin, MJ et al. Cognitive decline in women newly diagnosed with breast cancer (abstract), American Academy of Neurology's annual meeting in 2008.
Darby, DG et al. The acute cognitive effects of adjuvant chemotherapy in women with breast cancer (abstract), American Academy of Neurology's annual meeting in 2008.
Hede, K. (2008). "Chemobrain is real, but may have new name." J Natl Cancer Inst100 (3): 162-3, 169
Vardy, J., J. S. Wefel, et al. (2008). "Cancer and cancer therapy-related cognitive dysfunction: an international perspective from the Venice cognitive workshop." Ann Oncol19 (4): 623-9.