Chemo Brain- The Bane of Chemo-Therapy?

by Dr. Sunita Khatri

Many women, who have received chemotherapy, often notice difficulty in remembering certain things. They find it difficult to learn new tasks, and have trouble in completing the task in hand. This sort of mental cloudiness can be very frustrating. Many a times, these problems are not noticed by others, but the patients facing them know that their brain is no longer working as it used to before the treatment. This mental fog, in common parlance, has been termed as “Chemo Brain.” However, doctors prefer to address it as “mild cognitive impairment.”

The effects of chemo brain vary from patient to patient. Not all patients undergoing chemotherapy suffer from this condition. Certain experts suggest that 15% to 70% of patients undergoing chemotherapy suffer from chemo brain, while there are others who suggest that it is not seen in more than 50% of the patients undergoing chemotherapy. Also, while in certain patients, the effects appear shortly after chemotherapy and disappear soon after, in others, the effects may last up to 20 years following the treatment.

The common problems faced by patients with chemo brain include:

  • Lapses of memory
  • Difficulty in concentrating
  • Problem in multi-tasking
  • Problem in recollecting details like names, dates, etc.
  • Forgetting common words
  • Taking a longer time to analyze a problem and to find its solution

For some patients, these problems may be mild, but for others, especially those in a demanding job, they may be quite exasperating.

As more and more patients suffering from chemo brain have started discussing their problems with their physicians, the condition is being actively researched.

Chemo brain is a recognized medical problem now. Neuro-imaging has shown that patients who have undergone chemotherapy show a lower level of resting brain activity as compared to patients who have not undergone chemotherapy. Similarly, the patients with chemo brain use larger areas of brain, while undergoing a memory test.

In a recent study, published in the Journal of Clinical oncology, researchers have noticed that survivors of breast cancer, who took chemotherapy from 1970s to 1990s, performed poorly in tests for ability to recall words, co-ordination between thinking and hand movement, speed of processing information, etc., when compared with women of the same age group who did not receive any form of chemotherapy. The study has led the researchers to believe that the combination of chemotherapy drugs used in that period was responsible for the effect of chemo brain seen in these women.

However, another neuropsychological study done on 132 newly diagnosed patients of stage I-III invasive breast cancer showed that the patients had markedly lower cognitive performance even before the start of the chemotherapy. This has led researchers to believe that there may be other factors involved, apart from chemotherapy, in the development of chemo brain.

Patients with invasive cancer have an increased level of pro-inflammatory cytokines, which may contribute to chemo brain. Similarly, patients of breast cancer may receive drugs like tamoxifen and aromatase inhibitors, which may play a role in the development of this condition. Other factors that can contribute to the development of chemo brain include usage of medicines like pain killers and anti-emetics, age of the patient, stress levels, depression, infection, pattern of sleep, other co-existing medical conditions, blood counts, etc.

Considerable research is still required before doctors can pinpoint the reason behind chemo brain. And it is only after this is done, that the doctors will be able to find out the ways to prevent or treat the effects of chemo brain. As of now, it can be said that the benefits of chemotherapy to treat cancer far outweigh the problems arising because of chemo brain. Therefore, the patients should not deter treatment out of fear of developing chemo brain.

References:

http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/chemotherapyeffects/chemo-brain

http://jnci.oxfordjournals.org/content/100/3/162.full

http://jco.ascopubs.org/content/22/11/2233.abstract
 

Dr. Sunita Khatri passed her M.B.B.S from Shivaji University, Kolhapur, India. After completing her internship at S.B.D. Hospital, Saharanpur, she worked at the “Railways Cancer Institute” Varanasi in the department of surgical oncology where she gained hands on experience in various cancer surgeries. She has assisted in surgeries like mastectomies for breast cancer, abdomino-perineal resections for rectal cancers, commando surgeries for oral cancers, gastrectomy for stomach cancer, etc., besides routine operations like gastrostomy, ileostomy, etc. She has written multiple articles on various types of cancers and their treatment. She is a keen follower of the latest researches and development in the field of cancer and likes to share the same with her readers through her articles.

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