Mesothelioma survivor Michelle Marshall didn’t need a medical study to tell her the chemotherapy she received years ago had scrambled her ability to remember things.
She has one now.
“Chemo Brain” is an all-too-real issue for many people dealing with cancer, according to a recent study. Having foggy thoughts and forgetting routine things are a couple of the not-so-obvious side effects of chemotherapy that often get overlooked, despite the frustration it causes.
“My hair grew back. I don’t get sick to my stomach anymore. I’ve got energy again. But I still can’t remember things,” Marshall told Asbestos.com. “And I used to have a great memory. That’s the side effect they don’t warn you about.”
Chemotherapy as a cancer treatment often comes with physically and emotionally draining side effects. Nausea and vomiting, hair loss, fatigue, mouth sores and diarrhea can be exhausting, but they also normally pass in a relatively short period of time.
Cognitive impairment — commonly called Chemo Brain — can linger for years. And it’s as real as any of the more obvious side effects.
Marshall, 54, went through chemotherapy in 2002 and again after a cancer relapse in 2006. Before chemotherapy, she worked as an executive assistant to a high-powered CEO in New York City. Today she is on disability and essentially retired.
“I can get lost just driving out of my neighborhood. I can’t even imagine trying to multi-task again,” she said. “I’m glad they have a name for this now, but still it’s frustrating every day. I can remember things I did when I was six years old, but I sometimes can’t remember what I did yesterday.”
Breast Cancer Study at Moffitt
An extensive study at the Moffitt Cancer Center in Tampa reaffirmed what many otherwise healthy cancer survivors quietly have been dealing with in the aftermath of chemotherapy.
Although often dismissed by oncologists and overshadowed by more noticeable problems, Chemo Brain can frustrate and discourage cancer survivors for the rest of their lives.
Researchers at Moffitt analyzed 17 previous studies that included more than 800 breast cancer patients, concluding that verbal and visuospatial abilities — the ability to judge space, distance and dimensions — were at risk with chemotherapy.
“Earlier studies had reported conflicting evidence on the severity of cognitive deficits,” said Heather S.L. Jim, Ph.D., Moffitt’s lead author of the study, published in the Journal of Clinical Oncology. “But it (chemo brain) really does exist. There is data from other cancers, too, that suggest chemotherapy does effect cognitive function. And there is no reason to think it’s exclusive to breast cancer patients.”
Based on the study, patients previously treated with chemotherapy performed significantly worse on tests of verbal ability than individuals without cancer. And patients treated with chemotherapy performed worse on visuospatial ability than those treated without chemotherapy.
“For a lot of oncologists, it’s not always on their radar. Their focus is keeping patients alive, and preventing recurrence,” Jim said. “This often is overlooked, under reported. There is data to suggest that chemotherapy does cross the blood brain barrier and is associated with shrinking some areas of the brain.”
Explaining the Mental Fog
Cancer survivors, for many years, have been baffled by — and even joked about — the mental fog in which they find themselves after chemotherapy treatment. But only in recent years have studies been done to explain it.
According to the American Cancer Society, symptoms of Chemo Brain often include:
- Trouble remembering details they previously knew well, like dates and names.
- Taking longer than usual to complete simple tasks because the thought process is slower.
- Trouble remembering common words, making them unable to finish sentences.
- Memory lapses that cause them to forget simple things.
- Trouble with simple multi-tasking, like answering the phone and cooking at the stove at the same time.
Cancer survivors often don’t even mention it to their oncologist, and just find ways to deal with it. Sometimes, the problem fades away and the mind clears. Other times, it lingers and lingers.
“We found a lot of variety in the effects. Some people just breeze through it and never have a problem again,” Jim said. “Sometimes patients try and go back to work, and are just not able to function properly. It can be debilitating cognitively.”
Brain studies involving chemotherapy have been difficult to interpret. Most have not tested patients before chemotherapy to establish reliable baseline comparisons. There is a lack of consistency, too, among the research, including the time after chemotherapy it was taken, and the method of measurement.
The goal of the Moffitt study was a meta-analysis of cognitive functioning in breast cancer survivors, and clearly there were deficits in the functioning.
Ways To Overcome Chemo Brain
An encouraging cognitive function study done earlier this year at Indiana University, published in Breast Cancer Research and Treatment, does provide hope for those struggling with brain impairment.
The study detailed two different programs that helped reverse the loss of cognitive function. One involved simple memory training that included teaching strategies for remembering that include text material, word lists and sequencing.
The other involved a computer program called Insight, in which participants went through a series of progressively more difficult informational tasks. It is developed by Posit Science, a provider of brain fitness programs.
The study included 82 breast cancer survivors who undertook chemotherapy and expressed concerns about their cognitive functioning.
Many of the studies involving Chemo Brain and treatment to alleviate the problem involve breast cancer because the pool of survivors is so large. But doctors seem to agree that it’s a problem with other cancers, too.
“They are, thank goodness, benefiting from survival and are returning to work and their daily lives,” behavior neurologist Garrett Riggs, M.D., told the Orlando Sentinel. “But they are finding their memories and cognitive function isn’t what it was.”
- Marshall, M. (2012, Oct. 8.). Michelle Marshall phone interview with Asbestos.com
- Jim, H. (2012, Oct. 8.) Heather S.L. Jim, PhD, interview with Asbestos.com
- Large Review Finds Some Evidence for “Chemo Brain” in Breast Cancer Survivors, Moffitt Cancer Center Says. (2012, Sept. 4.) Moffitt Cancer Center. News release. Retrieved from http://www.moffitt.org/home/moffitt-in-the-news/press-releases/2012/breast-cancer-chemo-brain-9-4
- Nunley, A. (2012, Oct. 2.) Study: Therapy Restores Brain Processing In Chemo Patients. Indiana Public Media. Retrieved from http://indianapublicmedia.org/news/study-seeks-restore-cognitive-abilites-chemo-patients-37102/
- Jameson, M. (2012, Oct. 7.) Chemo Brain not just in cancer patients' heads. Orlando Sentinel. Retrieved from http://articles.orlandosentinel.com/2012-10-06/health/os-chemo-brain-breast-cancer-20121005_1_chemo-brain-cancer-patients-cancer-treatment