Cancer treatment is associated with the medical condition known as ‘chemo brain’. But there are ways to avoid this problem.
WASHINGTON POST – When you have finished the second round of chemotherapy for cancer breast cancer, Shannon Colleary tells her brain it looked foggy.
“I had no short-term memory,” says Colleary, 57, a Los Angeles screenwriter who finished treatment in October 2021. “I was like, ‘Why am I in this room? Who is this person who just said hi to me??How do I know her?’ So I pretended to know the person, but I often said hello without knowing who she was.”
“Blank” is how Justin Schuster, 19, of Rye Brook, New York, has described his brain since completing treatment for Hodgkin’s lymphoma in April. “My thoughts aren’t processed,” says Schuster, who dropped out of Lehigh University last December after discovering an enlarged lymph node just above his collarbone. “I can’t find the words and forget what I’m trying to say.”
It is often called what Colleary and Schuster describe “chemo brain” [chemo brain], the name for a debilitating medical condition characterized by an inability to concentrate and loss of speech, memory, and executive function. Doctors call this cancer-related cognitive impairment (CRCI), and research indicates that it affects about 75 percent of cancer patients during the process, with 35 percent reporting symptoms that persist after treatment ends.
It is not yet known why some people have the problem and others don’t, or why some people have symptoms that persist for years, while others get rid of them in a few months.
But Arum Kim, director of the Supportive Oncology Program at NYU Langone’s Perlmutter Cancer Center, advises people to talk to their medical team about cognitive changes.
“It’s important to have really good, calm communication with your cancer care team, because there are things we can do about it, if we know what’s going on,” she says.
What causes “chemo brain”?
Jeanne Mandelblatt, director of the Lombardi Institute for Research on Cancer and Aging, believes the cause may have to do with inflammation.
“Cancer treatment kills cancer cells, but it also causes damage that can accelerate aging and increase inflammation, even inflammation in the brain. And this can affect cognition,” says Mandelblatt, who leads the Thinking and living with cancer [Pensando e Vivendo com o Câncer]a fifteen-year longitudinal study focusing on breast cancer patients with cognitive impairment.
But “chemo brain” is a misnomer, he adds, because patients show cognitive impairment due in part to immunotherapy and the hormone therapyas well as chemotherapy. “It’s not all one thing, but it’s a concrete phenomenon and people have cognitive problems that interfere with their lives,” she says.
It’s also likely that chemo brain simply happens because of the cancer itself.
“When people go through cancer and are recovering, they face many other problems that can affect their function, but don’t necessarily impact their brain. The rate of insomnia is very high in this population. There can be high rates of anxiety and depression, there can be major lifestyle changes, and that can make them less functional than before,” says Nicolette Gabel, director of the division of rehabilitation psychology and neuropsychology in the University of Michigan Department of Physical Medicine and Rehabilitation.
Colleary says the overwhelming depression she felt during treatment was even worse than her short-term memory loss.
“It was very clear to me that the chemotherapy drugs had killed all the positive hormones in my brain,” she says. “Dopamine, serotonin, oxytocin and endorphins just didn’t exist. I was kind of nihilistic, thinking ‘What’s the point of life? It’s too dangerous and lonely and sad.’
treatments that work
Neuropsychologists such as Gabel and Eric Zhou, an assistant professor at Harvard Medical School who specialize in disease recovery, say that chemo brain treatment requires a multifaceted approach.
“It’s a combination of cognitive retraining and mindfulness practices to help reduce stress (AND) improves things like sleep and relaxation, as well as eliminates the high-cortisol type of stress that occurs when people are going through these changes,” says Gabel.
Zhou urges patients to talk to their doctors about cognitive symptoms as soon as possible. A recent study showed that patients’ symptoms improved with the following interventions:
Phisical exercises: In a study of more than 500 breast cancer patients, those who exercised 150 minutes a week maintained similar cognitive function to a control group without cancer, says Michelle C. Janelsins-Benton, study author and professor associate at the University of Rochester Medical Center.
“Individuals who were physically active at diagnosis, even if they didn’t remain so during treatment, had better cognitive performance than those who weren’t physically active before treatment,” says Janelsins-Benton.
She hypothesizes that exercise fights inflammation in the body, which may be a contributing factor. In another study, Janelsins-Benton found that moderate exercise also helps patients maintain their attention span. “We need more studies, but I think exercise is very promising in terms of its benefits,” she says.
Cognitive Behavioral Therapy (CBT): Resetting thought and behavior patterns can improve symptoms and make life easier, says Zhou.
“If you’re very forgetful in your head, it’s really helpful to create a very structured home environment so that you have a specific place for things,” says Zhou. “The use of calendars, especially those on cell phones and smartwatches that play alarms, can stimulate behavior.”
Since being treated for Hodgkin’s lymphoma when she was 19, Diana Pernicano, 29, a nurse in Yorktown Heights, New York, has kept a record. Her distraction was once so severe that she was eventually asked to quit her first nursing job because she too often forgot essential information about her.
“I was really embarrassed,” she says. “Fortunately, I was able to refocus and get a nursing job that I love.”
A type of CBT called memory and attention adaptation training is particularly effective, says Gabel, and is something patients can easily practice at home.
Sleep: Lack of sleep “magnifies the physiological changes that occur with brain chemo,” says Zhou. If you suffer from sleepless nights, consult your doctor to try CBT, which is considered the best method to deal with insomnia. Zhou says techniques include adjusting bedtimes, making the bedroom more relaxing, and “sleep restriction,” which involves limiting bed time to only hours spent sleeping, not reading, watching your TV or play anything on your smartphone.
Mindfulness practices: Meditation, deep breathing and yoga may improve cognitive impairments, according to a small study of breast cancer patients. “We’re not sure why this helps, maybe it’s a mind-body connection or because these things are good for us in general,” Zhou says.
Psychostimulants: Although there is no clinical evidence of its effectiveness yet, drugs like Adderall can help. “People who have a lot of attention problems and cognitive fatigue can experience a significant effect with these drugs,” says Gabel.
Fear of cognitive impairment may cause cancer patients to forgo treatments, but they shouldn’t, says Gabel.
“This can all sound very scary, and my concern is that people are going to reject treatments that might be curative,” she says. “Today cancer survival rates have reached levels that would have been unquestionable twenty years ago. It’s not certain that chemo brain will happen, and if it does happen, there are ways to address the problem.”
No FDA approved solution – yet
No drug approved by the US health agency, the FDA (Food and Drug Administration) is available for chemo brain, although Mandelblatt predicts it won’t be long before doctors can offer pharmaceutical solutions to their patients.
“We’re making progress and I hope that already approved drugs are reused for chemo brain,” Mandelblatt says, noting that the mouse studies are promising.
One such study showed that cisplatin, a widely used chemotherapy drug, alters sphingolipid metabolism in the hippocampus (where memory is stored) of the mouse brain and plays a key role in brain chemotherapy, says the study author. Daniela Salvemini, director of the Institute for Translational Neuroscience at St. Luigi University.
Salvemini’s team then administered fingolimod and Zeposia, drugs already approved by the FDA for the treatment of multiple sclerosis, and found that they could block the development of chemo brain in mice.
While human trials are needed, Salvemini says: ‘I think it could be a revolutionary approach to treating cancer patients and cancer survivors. We are very excited about this possibility. Chemo brain is a real problem. While it doesn’t affect everyone, it has a serious impact on the lives of the people it affects”./ TRANSLATION BY RENATO PRELORENTZOU
Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
