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Lifting the Fog on Chemo Brain

Jamie Myers, PhD, RN

October 07, 2019

I can recall the first time I heard about chemo brain. I had been a nurse in oncology for more than 20 years and had administered chemotherapy to people with cancer for many years.

In 2007, while pursuing my doctorate, I attended an oncology nursing society regional conference and listened to a panel comprised of a neuropsychologist, oncology nurse and a cancer survivor. Prior to her breast cancer diagnosis, the patient had worked as an intensive care unit nurse. However, after treatment – including chemotherapy – she chose to leave her job because she no longer felt cognitively fit to perform her demanding role.

Her story shook me. I had done so much work with chemo, yet I had done nothing to educate patients or other nurses about this possible side effect. I then knew that I needed to devote my research to this little-understood phenomenon.

What is chemo brain?

Cognitive impairment following cancer treatment is a common symptom reported by about 3/4 of cancer survivors. The range of issues reported include a foggy or fuzzy brain, impaired short-term memory and concentration, trouble finding the right words, difficulty multitasking and misplacing everyday items. Chemo brain can have a significant effect on quality of life. And, as I learned during that life-changing panel discussion, may even affect your career.

The term “chemo brain” can be misleading. The term implies chemotherapy is the sole cause. In truth, the phenomenon is broader – and more complicated – than that. The cognitive changes a cancer survivor may experience can be caused by many other forms of treatments, including endocrine therapy, as well as the cancer itself. Add in other factors frequently accompanying a cancer diagnosis – fatigue, anemia, difficulty sleeping and depression or anxiety – and the complexity deepens. As we have uncovered more clues to chemo brain, research has shifted to encompass these factors.

An uptick in research

Currently, no standard therapy exists for chemo brain. Most of the available neurocognitive tests were developed for patients experiencing cognitive issues related to head injury and dementia – not to the subtler cognitive effects of cancer and cancer treatment. In fact, cancer survivors typically perform well on these tests, but they know they are working harder than prior to their diagnosis and treatment.

This gap in care has served as a springboard for more research to help us better understand and treat chemo brain.

Hannes Devos, PhD, DRS, and the University of Kansas Medical Center’s School of Health Professions are working to identify techniques to assess cognitive changes in people with movement disorders like Parkinson’s or with neurocognitive diseases such as Alzheimer’s. Together with The University of Kansas Cancer Center and KU School of Nursing, we’ve expanded this research to include breast cancer survivors. We are investigating the measurement of cognitive effort by utilizing eye-tracking software that monitors pupil dilation. Participants perform a series of mental challenges, and the more challenging the cognitive task, the more the pupils dilate. There are 2 participant groups – women with breast cancer and women with no history of cancer. We discovered that, based on pupil dilation, cancer patients demonstrated greater cognitive effort to get the same result on tasks.

Through the support of a pilot grant from The University of Kansas Cancer Center, we are conducting a sub-study in which participants also complete a driving simulation task while we measure pupil dilation.

In addition to investigating better ways to measure cognitive effort, our team studies potential interventions to improve cognitive function in cancer survivors. We collaborated with members of the Masonic Cancer Alliance to study the effects of mindfulness-based exercise on cognitive function. Called Qigong (pronounced chee-gong), this practice is a close relative of tai chi that involves rhythmic breathing, flowing movement and meditative chants. Qigong is fairly simple to learn and perform. It can even be done while seated.

Qigong has an exercise component, and exercise is valuable on so many levels. Exercise reduces chronic inflammation, increases circulation and blood flow to the brain. Some research also shows exercise benefits cognitive function. We just published promising findings from the pilot study, which demonstrates that adding a mindfulness component to exercise may enhance the positive impact on cognitive function.

We are also collaborating with Cedars Sinai Medical Center in Los Angeles to study the effects of 6 weekly psycho-educational intervention sessions for people with chemo brain. Dr. Susan Krigel, clinical psychologist with MCA, and I have been locally hosting these weekly sessions via interactive televideo broadcast by Cedars Sinai. Participants report positive results and we are working on a larger study design.

Thanks to another pilot grant, we added a cognitive component to School of Nursing Dean Sally Maliski’s Staying Strong and Healthy study of men receiving androgen deprivation therapy for prostate cancer. Participants receive a diet and exercise intervention to decrease the risks of many side effects related to prostate cancer treatment. We are collecting data on participants’ performance on neurocognitive tests over time during their prostate cancer treatment.

Educate yourself

To those experiencing changes in cognitive function related to cancer and cancer therapy, you are not alone. These cognitive changes are very real and have been documented across a number of types of cancer diagnoses. Educate your friends and family so they can understand the changes you are going through.

We don’t have a standard of care yet, but the evidence from research is starting to identify some helpful strategies. If you have a study in your area for which you qualify, consider participating. If not, talk with your healthcare team about ways to make exercise part of your life, consider learning about mindfulness strategies and ways to improve your diet (decrease sugar and fried foods, increase foods rich in antioxidants and Omega 3 fatty acids).

I have witnessed how frustrating chemo brain can be, and that’s why I have dedicated my research to better understanding – and ultimately, better treating – this phenomenon.

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