Understanding Cancer-Related Cognitive Dysfunction – ‘Chemo Brain’

Cancer-related cognitive dysfunction, frequently referred to as “chemo brain,” has been reported in as many as 75 percent of people receiving cancer treatment.

Cancer care experts such as M. Beatriz Currier, M.D., director of the Cancer Patient Support Center at Miami Cancer Institute, say the term “chemo brain” does not accurately represent the multiple processes that contribute to cognitive dysfunction in individuals with cancer. Knowledge and understanding of the condition has empowered clinicians to take steps to minimize its impact.

“There is an increasing number of cancer survivors, and with this good news comes a heightened focus on improving survivorship issues that include quality of life and school and work reintegration after treatment,” said Dr. Currier.

Multiple Factors Contribute to the Condition
Inflammation is a central cause of cancer-related cognitive dysfunction, Dr. Currier says. There are several scenarios that can lead to inflammatory responses. These include:

• Chemotherapy and other medications, which can cause damage to neurons and other brain cells.
• Radiation therapy, which can cause functional and structural effects on the brain.
• The disease itself. “Studies have shown that some patients have experienced cognitive decline before beginning cancer treatment,” said Dr. Currier.
• Surgery

Patients with the following risk factors also may be vulnerable to cancer-related cognitive dysfunction:

• Advanced age. “Older people and those with baseline cognitive impairment may have less cognitive reserve to deal with the insults of cancer and its treatments,” Dr. Currier explained.
• Mood disorders, such as anxiety and depression.
• Chronic stress and fatigue.
• Menopausal symptoms and the use of hormonal therapy, specifically tamoxifen.
• Genetic predisposition. “Certain genes have been found to play a role in the cognitive decline of individuals receiving chemotherapy, and certain chemo therapies have more of an impact on brain structure,” Dr. Currier said. “Gene testing before cancer treatment can help identify those patients at risk for cognitive decline and, therefore, help guide oncologists and patients in their treatment choices.”

Symptoms Affect Overall Well-Being
Symptoms of cancer-related cognitive dysfunction include loss of short-term memory, difficulty in maintaining attention, inability to concentrate, reduced processing speed and impaired multitasking. “Some adults returning to work find that they have trouble keeping up and staying focused, and some students may experience a drop in academic performance,” Dr. Currier explained. “Cognitive deficits can have a profound impact on employment or academic goals and overall quality of life.”

For many people, the symptoms are subtle and short-lived. But others may experience continuing deficits well beyond the active treatment phase. Fortunately, there are cognitive training strategies and other therapies that may reduce the burden of cognitive impairment.

Interventions Improve Impairments
“At Miami Cancer Institute, diagnosing and treating cognitive dysfunction is part of a patient’s comprehensive treatment plan,” Dr. Currier said. “We evaluate patients in our Brain Fitness Lab, obtain a definitive diagnosis and start therapy right away.”

During the 12-week cognitive remediation therapy program, patients meet with an occupational therapist and a speech therapist two to three times a week. For people who cannot commit to this schedule, a computer-based brain fitness program accessed at home 30 minutes a day, five days a week for six weeks also has proven effective. Both programs focus on improving attention, concentration and memory skills.

The Institute’s Survivorship Program also includes nutritional counseling to help patients maintain a healthy diet and physical activity assessments and fitness training. “Aerobic, resistance and mindfulness-based exercise have been shown to improve decision-making abilities,” Dr. Currier explained. “Mild to moderate exercise can reduce inflammatory markers and enhance cognitive performance.”

Dr. Currier and other experts warn that the fear of acquiring cancer-related cognitive dysfunction should not deter individuals from receiving potentially beneficial treatment that could cure or control the disease. The good news is, positive steps have been made to deliver personalized treatments that minimize cognitive dysfunction and provide therapy programs that remediate the effects.

Tags: chemotherapy, Miami Cancer Institute