Articles of interest

Chemo Brain

(Article from Orlando Sun-Sentinal)

Chemo brain, the foggy thinking that cancer patients often complain about and doctors often dismiss, just got a jolt of validation from a large new study out of Moffitt Cancer Center in Tampa.

Researchers there analyzed 17 previously published studies that looked at cognitive function in breast-cancer patients after they had undergone chemotherapy.

They found that the average cancer patient suffered impairments in verbal abilities, particularly in ability to find words, and got lost more easily than those who never had the cancer treatment.

Julie Tharp of Oviedo welcomed the affirmation.

"The minute I saw the study, I printed it off and hung it on the door of my office. I told my colleagues and husband, 'See, I'm not crazy. Chemo brain is real!' "

Tharp, 51, a home-care agency manager and mother of two college-age sons, was diagnosed with cancer two years ago, then had six months of chemotherapy. Soon after, going into a room and not knowing why she was there became common, she said.

Today, her brain works better than it did during the hazy months of chemo, but "my memory has never come back to what it was," she said. "It's as if my brain doesn't have the same triggers that remind me to do things."

Tharp never mentioned the memory problems to her doctor, nor did he tell her that cognitive impairment was a common fallout of chemotherapy.

"I never thought to mention it because I found ways of dealing with it," she said.

Not all cancer experts bring the subject up.

"Some oncologists are very aware of this," said Heather Jim, a Moffitt researcher and lead author of the study. "But for others, it's not on their radar."

The oncologist who treated Debra Ellison, 57, of Port St. Lucie fell into the latter camp.

Ellison, a data processor for a medical-supply company, had four months of chemotherapy in 2009 after her breast-cancer diagnosis. "I thought I was going crazy," she said of the memory problems that started.

"When I told my oncologist, he said, 'There's this thing called chemo brain, but I don't believe in it.' "

Ellison still has times when she can't find words, and her attention span is much shorter. Sometimes, in the middle of a conversation, she forgets what she's talking about.

When she learned that chemo brain was real, she felt relieved.

"It's frustrating when people don't believe you," she said.

Most studies to date have focused on breast-cancer survivors because they make up such a large pool. But chemo brain is common among survivors of other types of cancer as well, said Dr. Garrett Riggs. A behavioral neurologist at M.D. Anderson Cancer Center Orlando, Riggs sees many patients who have complications following cancer treatment.

"They are, thank goodness, benefiting from survival and are returning to work and their daily lives and finding their memories and cognitive function isn't what it was," Riggs said of the typical patient he sees.

This is your brain on chemo

In studying nearly 1,500 subjects, Moffitt researchers found that cognitive functioning varied across survivors. Some reported no impairment and others reported severe deficits, said Jim, whose research is funded by the National Cancer Institute, part of the National Institutes of Health.

Medical scientists aren't sure why the brain takes a hit after chemo, but animal studies have shown that subjects exposed to chemotherapy agents have a decreased number of nerve cells in the memory center of the brain than those in control groups, Riggs said.

Functional MRIs tracking blood flow to different parts of the brain suggest that breast-cancer patients who have had chemo have to tap more areas of the brain when performing the tasks than those who never had cancer or chemo, Jim said.

Studies also indicate that regions of white and gray matter get smaller in cancer patients post-chemo.

A way to recover

Though patients typically recognize that their cancer therapy saved their life, and they're grateful, they also wonder whether they can recover the mental function they've lost, Riggs said.

That's what researchers are looking into next.

"We're asking what patients can do before and after chemo to prevent cognitive loss, and also whether the type of chemo makes a difference," said Jim, adding that survival and preventing recurrence are "first and foremost."

Scientists are looking at drugs that might help cancer patients recover some of their lost function, "but one thing that appears to help is mental exercise," Riggs said.

Tharp and Ellison have adopted some tricks to compensate, including making more lists.

"I double-check myself," said Tharp, "and ask my co-workers and my husband to remind me of things, which is funny because I used to remind him."

Ellison wishes more doctors were aware of the problem.

"If I'd known [before my treatment] that this could happen, I could have been prepared — not confused," Ellison said. "I wish more doctors understood and didn't blame the problem on age or hormones."

For those chemotherapy patients who do experience cognitive setbacks, Jim suggests they see a neuropsychologist, who can help them develop strategies to compensate.

"Research shows that such strategies can make a big difference in daily life when cognitive difficulties do arise," she said.

The other day, Tharp saw a quote she liked: "Courage is just fear on prayer." Before chemotherapy, she said, she would have relied on her memory to store it away. Not these days. She took out her iPhone and snapped a picture of the quote. 

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