March 21, 2014 | by Denise Heady
Cancer treatments obviously save lives, but sometimes at a high price, with side effects that can have a lasting impact. One of those side effects is a mental cloudiness often referred to as "chemo brain."
Chemo brain is clinically known as cancer-related cognitive dysfunction – mental changes that occur in cancer patients during or after treatment. Patients can have trouble concentrating, remembering details like names and dates, and multitasking; they might also need longer to complete tasks and they can experience memory lapses, according to the American Cancer Society.
Although patients and caregivers have noticed chemo brain effects for sometime, serious research on the subject has only recently begun. City of Hope oncology nurse Denice Economou, R.N., M.N., C.N.S., A.O.C.N., discusses some of the causes of chemo brain and what patients can do about the condition.
What causes chemo brain?
Multiple factors contribute to the development of cognitive dysfunction. Chemo brain may be related to chemotherapy, and it is known that certain drugs are at higher risk. Cyclophosphamide, methotrexate and fluorouracil have a high association with increased risk, but depending on the dosing, the level of dysfunction may be minimal or moderate to severe. Higher doses and longer treatment regimens increase the exposure to the drugs and increase the probability of developing chemo brain.
Premenopausal women experiencing estrogen and progesterone reductions also experience changes that include memory loss and reduced ability to maintain focus or attention. Medications such as pain medications, sedatives and anti-nausea medications may also contribute.
What are the symptoms of chemo brain?
Cognitive functions that can be impacted include language ability, memory, concentration, and attention or focus. Patients may then become distressed or anxious. Higher-functioning people may recognize their deficits far more than some others; most patients only notice subtle changes.
It is believed that 50 percent of breast cancer patients who have received chemotherapy may experience some level of cognitive dysfunction, and studies have shown that a small minority of those patients may experience residual effects for up to 10 years after treatment.
Although breast cancer patients have been the most studied for cognitive disorders, both men and women who have been treated for hematologic cancers or received bone marrow transplants – or men with testicular cancer – have also experienced cognitive changes. Due to the severity of other symptoms, chemo brain or cognitive changes in these populations may go under-reported.
How long does chemo brain last?
Depending on the amount of time the patient has been exposed to the chemotherapy, and if other causes are managed, the dysfunction may be an acute problem that improves as the patient gets further away from the chemotherapy dose. As I stated earlier, a small minority of patients may experience chemo brain even 10 years later. Those are probably related to additional factors that do not improve, such as stroke, changes in circulation, endocrine changes, normal aging or Alzheimer's.
How can patients cope with the effects of chemo brain?
Of course, this is always an individual response. It depends on the age of the patient and the quality of day-to-day activities he or she may be doing. Young adults working in stressful situations where they need to be able to multitask and make decisions quickly may have a much more difficult time getting back to work and functioning. Usually most patients can return to their previous jobs (at least in the breast cancer patients I have known), but there is the occasional one who cannot.
I know of one patient who was a stage manager in the movie business. Her job was to be sure that all the props were in the same position all the time for filming. So lots of money was riding on her making sure that all the lamps, for instance, were in the same position in a room; otherwise when filming the next day, things would not look right and could mean a day's worth of film was useless. I don’t know if she was ever able to return to work. Her problems are an example of those that can be experienced by a younger person, and the increased risk of moderate-to-severe consequences postchemotherapy. Working with occupational therapists or behavioral modification strategies may help.
What types of treatments are available for chemo brain?
Treatment would begin with trying to fix the fixable causes. Correcting anemia to increase oxygenation to the brain and administering methylphenidate as a stimulant may help with attention-deficit disorder or fatigue related cognitive changes (chemo brain).
Hormone replacement therapy has had controversial results. Interestingly, in normal woman, estrogen reduction is associated with memory loss and attention disorders, and as we know estrogen replacement in breast cancer patients is detrimental so not recommended. But a Women’s Health Initiative study observing more than 161,000 women over a 15-year span is looking at the development of cognitive dysfunction in healthy postmenopausal woman. They have found an increased risk of the development of dementia in women taking combination estrogen/progesterone therapy. Although many women think lack of estrogen is their main problem, the data is not yet known, and replacement is definitely not recommended at this time.
Additionally, treatments for Alzheimer disease are appropriate for those diagnosed with the disease. Ginko biloba has shown beneficial effects on cognitive function, but further research is pending because there are side effects related to increased vasularization and increased bleeding times associated with this extract, which is counterproductive in cancer patients.
When is chemo brain most likely to materialize?
For most patients, this would be with initial treatment and would dissipate as the patient gets further and further away from treatment. Again, the chronic chemo brain patients are rare, and the problems are usually associated with other physiologic changes associated with cognitive function.
Does chemo brain affect the way a patient is treated?
Patients at risk for chemo brain, or possibly experiencing pretreatment notable changes, would certainly be affected by the need to consent for treatment. Patients need to be informed of the potential and evaluated by health care professionals for increased risk based on the information I spoke of earlier. Quality of life is related to the four domains of care: physical, psychological, social and spiritual. Every patient is different and every domain is relatively related to the individual patient’s desires or needs.
Watch our Ask the Experts presentation "Coping with Pain, Fatigue and Chemo Brain From Cancer Treatment."