'Chemo brain' may occur before treatment even starts

December 7, 2012 by Barbara Bronson Gray, Healthday Reporter
'Chemo brain' may occur before treatment even starts
Study suggests mental fog, fatigue tied to chemotherapy may be partly due to stress.

(HealthDay)—So-called "chemo brain"—problems with thinking, concentrating and remembering that are associated with receiving chemotherapy—may actually start to occur before the treatment is initiated, a small new study suggests.

In the new study, pre-treatment mental fog and fatigue were associated with thought-process problems (also called "cognitive" problems) that have previously been assumed to be directly related to the treatment.

"It's hard not to believe that could damage the brain, but we found evidence of the problems occurring in many women even before the therapy had begun," said lead author Bernadine Cimprich, associate professor emerita at the University of Michigan School of Nursing.

Cimprich said previous studies on the mental effects of chemotherapy have offered a range of conclusions, but she felt none fully answered key questions about the cause of the mental fog and fatigue, and the timing of those problems. She and her colleagues wondered whether the stress of anticipating chemotherapy and treatment could be responsible for at least a portion of the chemo-brain experience.

"Our study isn't saying chemo brain doesn't exist but that there are other factors that may make women vulnerable to it and may compound the impact," Cimprich said.

The research was scheduled to be presented Friday at the San Antonio Breast Cancer Symposium. Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Chemotherapy involves treatment with cancer-killing drugs that may be given intravenously (injected into a vein) or by mouth. It is given in cycles, with each period of treatment followed by a recovery period, and treatment usually lasts for several months.

The researchers tested 97 women, including 65 who had localized breast cancer and 32 healthy women without cancer. The women with cancer had all had surgery, while 28 were going to receive chemotherapy and 37 were going to receive radiation therapy. Before treatment and a month after treatment was begun, the participants performed a verbal memory task during functional MRI brain imaging and reported on their fatigue levels.

Women who underwent chemotherapy performed less accurately on the mental task tests both before treatment and after treatment. They also reported a higher level of fatigue.

Why did the women anticipating chemotherapy show a greater incidence of chemo brain than did those who were awaiting radiation therapy? "Anticipation of toxic side effects may increase the burden of distress," Cimprich said.

"It's a big decision for a lot of women, especially when they have a choice [of whether to have chemotherapy or not]," she explained.

Cimprich said the research is encouraging because it suggests that early intervention may reduce or even prevent thought-process problems in women who will be getting chemotherapy. "It opens up the paradigm of attack. If the problems were only caused by the chemotherapy, there wouldn't be much we could do to prevent them," she explained.

There are probably multiple sources of the thought-process difficulties women with breast cancer experience, Cimprich said, including worry and concern about the prospect and potential impact of chemotherapy.

Cimprich said there are several things health care providers can do to help eliminate the problems, including being aware that these issues can begin before treatment. She added that it is important that care providers understand that women awaiting chemotherapy are more vulnerable to thought-process problems related to chemotherapy and fatigue. "We may be able to identify women at greater risk," she said.

Preventive treatment options, Cimprich said, include exercise and activity, cognitive behavioral therapy and mindfulness therapy, such as meditation.

Dr. Julie Gralow, a professor in the medical oncology division of the University of Washington School of Medicine and director of breast medical oncology at the Seattle Cancer Care Alliance, said the study was well done and will change the way she talks with women with facing treatment after surgery.

Gralow said that when she's warning women about the potential issues associated with chemotherapy, she'll be sure to say, "You may already be experiencing some of this now."

Explore further: Breast cancer survivors struggle with cognitive problems several years after treatment

More information: Learn more about chemotherapy for breast cancer from the American Cancer Society.

Related Stories

Breast cancer survivors struggle with cognitive problems several years after treatment

December 12, 2011
A new analysis has found that breast cancer survivors may experience problems with certain mental abilities several years after treatment, regardless of whether they were treated with chemotherapy plus radiation or radiation ...

Follow-up study finds prolonged fatigue for those who had chemotherapy for breast cancer

December 5, 2011
In a follow-up study, researchers at Moffitt Cancer Center and colleagues have found that patients who receive chemotherapy for breast cancer might experience prolonged fatigue years after their therapy. The new study, published ...

Stress contributes to cognitive declines in women with breast cancer, researcher says

April 11, 2012
Women undergoing treatment for breast cancer can experience cognitive declines, such as decreased verbal fluency or loss of memory and attention. Often experienced by patients undergoing chemotherapy, the declines have become ...

Researchers find cancer therapies affect cognitive functioning among breast cancer survivors

April 20, 2012
Researchers at Moffitt Cancer Center and colleagues at the University of South Florida and University of Kentucky have found that breast cancer survivors who have had chemotherapy, radiation or both do not perform as well ...

Trastuzumab and chemotherapy improved survival in HER2-postive breast and brain cancer patients

July 18, 2011
The use of trastuzumab, chemotherapy and surgery among women with HER2-positive metastatic breast cancer significantly improved survival from the time central nervous system metastases were diagnosed.

Recommended for you

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

Dulling cancer therapy's double-edged sword

January 17, 2018
Researchers have discovered that killing cancer cells can actually have the unintended effect of fueling the proliferation of residual, living cancer cells, ultimately leading to aggressive tumor progression.

Presurgical targeted therapy delays relapse of high-risk stage 3 melanoma

January 17, 2018
A pair of targeted therapies given before and after surgery for melanoma produced at least a six-fold increase in time to progression compared to standard-of-care surgery for patients with stage 3 disease, researchers at ...

T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma

January 16, 2018
WASHINGTON-(Jan. 16, 2018)-Tumors have come up with ingenious strategies that enable them to evade detection and destruction by the immune system. So, a research team that includes Children's National Health System clinician-researchers ...

Researchers identify new treatment target for melanoma

January 16, 2018
Researchers in the Perelman School of Medicine at the University of Pennsylvania have identified a new therapeutic target for the treatment of melanoma. For decades, research has associated female sex and a history of previous ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.