Chemo Fog at a Glance

August 3, 2016 at 9:27 am  •  0 Comments

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‘Chemobrain’, or chemo therapy related cognitive dysfunction, is the idiom used to describe the alterations in cognitive functioning reflecting the central nervous system toxic effects of systemic chemotherapy.1  Studies suggest that approximately 40% of cancer patients have evidence of chemo brain before any treatment, up to 75% may have cognitive decline during treatment (e.g., problems with memory, executive functioning, and attention) and up to 60% exhibit deterioration in cognition even after completion of therapy.2  With over 14.5 million cancer survivors in the United States, up to 3.9 million individuals may be living with long-lasting cognitive difficulties from cancer and cancer treatments. This is an important area, because these could influence adherence to treatments and lead to long-term impairment.3,4

Cognitive problems with chemotherapy can negatively impact activities of daily living such as 1) work performance, 2) access to medical and other health services, 3) caring for and socially interacting with family members.4 How do we know that cognition is not affected by the simple diagnosis of cancer as well?   For example, several studies have shown cognitive deficits in cancer patients before chemotherapy.  In one study 33% of patients had cognitive impediments in verbal learning and memory prior to chemotherapy.4  Another recent study revealed that 23% of women being treated for breast cancer had difficulty before chemotherapy.5 These could be related to psychological variables related to cancer diagnosis (e.g., stress, anxiety, depression) or to other factors (e.g., cognitive reserve).

Most conventional chemotherapeutic agents appear to concentrate their effect on cell proliferation. However, cell proliferation is a characteristic of many normal cells, so these agents also have toxic effects on normal cells.  Research has demonstrated that these drugs can damage neural progenitor cells – a form of precursor cells which create nerve and glia cells within the brain.6 Inflammation is a potent factor enhancing chemo brain.  It’s been found that 56 of the 132 FDA approved chemo agents area known to be strong sources of oxidative stress (i.e.: inflammation).7 Further, one major inflammatory cytokine –IL-6 – was found to negatively impact on the ability of nerve cells to regenerate.  8

 Nonetheless, trying to focus (no pun intended) on trying to offset chemo fog is crucial to not only yourself, but your family, work, and all those who count on you.  There are several strategies that can be implemented that might help combat chemo brain before, during, and after treatments.  These include behavioral strategies, such as cognitive training, which can be found at the following link: cognifit.com. Additionally, studies have shown an improvement in cognitive function with implementation of physical activity.9 Daily physical activity increases neurogenesis (new neurons), decreases inflammation, and stimulates positive brain vasculature changes (helps blood flow to the brain). Currently there are no pharmaceutical drugs that can be prescribed for this condition.  Employing the “buddy system” might also serve well in the journey!

Making daily notes can help to offset the inability to remember things, places, and events going on in your life.  Having family and friends to aid in this rehabilitation is important.  It may be as simple as having them follow-up on bills, whether it is checking monthly to make sure they were paid, or having them help you set them up on auto-pay.  Asking for help and support, whether it is family or friends, or support groups in essential for helping you manage life since there is already enough going on while you fight your battle with cancer!

 

References

  1. Simó, Marta, et al. “Chemobrain: a systematic review of structural and functional neuroimaging studies.” Neuroscience & Biobehavioral Reviews8 (2013): 1311-1321.
  2. Wefel, Jeffrey S., et al. “Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer‐related cognitive impairment in adults.” CA: a cancer journal for clinicians2 (2015): 123-138.
  3. Schagen, S. B., et al. “Monitoring and optimising cognitive function in cancer patients: Present knowledge and future directions.” European Journal of Cancer Supplements1 (2014): 29-40.
  4. Janelsins, Michelle C., et al. “An update on cancer-and chemotherapy-related cognitive dysfunction: current status.” Seminars in oncology. Vol. 38. No. 3. WB Saunders, 2011.
  5. Reid-Arndt, Stephanie A., et al. “Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors.” Journal of psychosocial oncology4 (2009): 415-434.
  6. Jansen, Catherine E., et al. “A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients.” Supportive Care in Cancer10 (2011): 1647-1656.
  7. Monje, Michelle, and Jörg Dietrich. “Cognitive side effects of cancer therapy demonstrate a functional role for adult neurogenesis.” Behavioural brain research2 (2012): 376-379.
  8. Myers, Jamie S., Janet Pierce, and Thomas Pazdernik. “Neurotoxicology of chemotherapy in relation to cytokine release, the blood-brain barrier, and cognitive impairment.” Oncology nursing forum. Vol. 35. No. 6. 2008.
  9. Hotting K, Roder B. Beneficial effects of physical exercise on neuroplasticity and cognition. Neurosci Biobehav Rev. 2013; 37:2243-2257.

 

Image compliments of @unsplash

 

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