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STUDY OF BREAST CANCER PATIENTS SUGGESTS 'CHEMO BRAIN' IS REAL

November 14, 2011|By Karen Kaplan, Los Angeles Times

Heres new evidence that the condition known as chemo brain is real: A study of breast cancer patients finds that women who had chemotherapy along with surgery to treat their disease had more trouble kicking their brains into high gear than women who were treated with surgery alone. They also performed much worse on tests of mental function than a group of healthy women who served as controls. The study, published Monday in Archives of Neurology, included 25 breast cancer survivors who had surgery and chemotherapy, 19 breast cancer survivors who had surgery but no chemotherapy, and 18 women with no history of breast cancer who were picked because their ages, level of education and menopausal status were similar to those of the women who had chemo. All of the study volunteers were asked to solve a series of brain teasers while their brain activity was recorded by an MRI machine. Volunteers also took a standardized test to measure their executive function and another test to assess how well they thought their brains were working. The functional MRI results showed that areas of the brain involved in memory, planning and attention werent as active in the women who had chemo as in the other breast cancer survivors or the healthy controls. The women in the chemo group took longer to recognize patterns in a card-sorting game administered by a computer. Worse still, even though the chemotherapy-treated women took more time on this task, they still made more errors, according to the study. The results probably wont come as a surprise to these women in the tests used to assess how well they thought their own brains were functioning, the women who had chemo reported more problems with executive function tasks than women in the other two groups. (The researchers also noticed some functional differences in the brains of breast cancer survivors who did not have chemo, but those differences didnt seem to translate into problems with problem -solving tasks.) The findings suggest that chemotherapy may cause neurotoxic brain injury, the study authors wrote. But its also possible that the disease itself may be responsible. After all, the women who got chemo tended to be diagnosed with more advanced cases of breast cancer than the women who were treated with surgery alone. Teasing apart whether the aggressiveness of the cancer or the chemo used to fight it is most to blame will take further study, the authors wrote.

CAN CANCER DRUGS HARM YOUR MEMORY? PATIENTS COMPLAIN OF MENTAL PROBLEMS AFTER CHEMO
By RACHEL ELLIS UPDATED: 23:56 GMT, 18 May 2009 When Sue Kernaghan underwent chemotherapy for aggressive breast cancer, she'd been warned severe sideeffects were par for the course. This is because the toxic drugs that are used to attack the cancer cells also affect the healthy cells, causing temporary problems such as hair loss, dry mouth, sickness, lethargy and forgetfulness. Indeed, during her seven months of chemotherapy, Sue suffered all these symptoms. But what she had not anticipated was to be still experiencing dry mouth and, more significantly, cognitive problems six years after her treatment. 'After my chemotherapy, I was in a state of shock because I was trying to cope and couldn't. Then it dawned on me that I wasn't getting my cognitive skills back,' says Sue, 56, a single mother, from Ellesmere Port, Cheshire. 'I would forget things I shouldn't forget, such as conversations I'd had with people, even when they reminded me. I couldn't multi-task in the way I used to. 'People said my loss of memory was my age or changes in hormones, but it is more than that. I never got my brain back. 'Recently, I went to watch a football match and two days later I wasn't able to remember the score. I really have to think about things to recall them and because I can't always remember things, it makes me worried and anxious.' As a result of her cognitive problems, Sue, who has a 27-year-old daughter, had to give up her senior managerial position in the NHS. 'My job required lots of multi-tasking and I couldn't do it any more. They were very good and tried to rehabilitate me, but I just couldn't cope and I applied for another job,' she says. Sue is one of many thousands who suffer from chemobrain: an impairment to their memory, concentration and the way they think caused by chemotherapy. This can occur as a short-term problem - Kylie Minogue complained at the time of her treatment for breast cancer that chemo had made her forget everything - but for many patients it never improves. For years, doctors and scientists have concentrated their work on trying to improve cancer survival rates, with much success. Figures published last month by Cancer Research UK, for instance, showed the number of women dying of breast cancer fell to less than 12,000 in 2007 - the lowest number since records began in 1971. Indeed, as a result of medical advances, there are two million cancer survivors in Britain. But as a result of their treatment - surgery, chemotherapy and/or radiotherapy - around a third have long-term side effects. These can include incontinence, tiredness and chemobrain, says Macmillan Cancer Support. Yet despite the huge numbers involved, 'not enough attention has been given to the effects cancer treatment has on the daily lives of patients', says Professor Jessica Corner, chief clinician at the charity. 'There has been a tendency for health professionals not to give patients enough detail and information about how they will be affected by cancer treatment,' says Professor Corner. 'This means they haven't been prepared for it, nor are they able to plan around it.' That is now changing, and cancer charities provide patient information about the possibility of long-term chemobrain before they start their treatment. Last year, the Department of Health also launched the National Cancer Survivorship Initiative to look at these issues. But our understanding about chemobrain (also known as chemo fog) is still in its infancy. Breast cancer patients were the first to report long-term chemobrain, and so far most of the research - around 100 published medical papers worldwide - have concentrated on these women. According to Cancer Research UK, up to 50 per cent of breast cancer patients who undergo chemotherapy suffer from chemobrain. While for most patients, symptoms go or really improve within a year of ending treatment, research published in the Journal Of Clinical Oncology found brain dysfunction continued for up to ten years in some breast cancer patients. Swedish research published last year found that men undergoing chemotherapy for testicular cancer also experienced a range of thinking problems. About one in three who had chemotherapy between four and 21 years previously had language problems, compared with one in six men who hadn't had any chemotherapy.

One theory is that chemotherapy affects the brain's ability to grow cells. This could explain why chemobrain is more likely in older patients, whose brains are also affected by age-related deterioration, and those receiving more intensive treatment. But, as Professor Corner explains: 'It is difficult to predict who it is going to affect. Some people sail through the treatment; others say they experience long-term problems.' According to Cancer Research UK, taking aspirin - which maintains or increases blood flow to the brain cells and so increases their oxygen supply - may be a way of preventing or treating chemobrain in the short term. Another possibility is stimulants given to people with chronic fatigue syndrome. Long-term, the charity recommends keeping your mind active by doing puzzles, exercising and eating healthily, making lists and keeping life simple. However, some experts are not convinced that chemotherapy itself causes cognitive problems - long-term or short-term. Professor Karol Sikora, former clinical director of cancer services at London's Hammersmith Hospital and now medical director of the independent organisation CancerPartnersUK, says there is still a question as to whether the condition is real. 'It is the same issue as with ME (chronic fatigue syndrome). Is this condition real?' he says.

'We know that when you combine chemotherapy with radiotherapy, there can be some cognitive impairment, which tends to occur a few months after treatment. 'Tests on children with leukaemia, who receive intensive chemotherapy, have shown the drugs do have an effect on their ability to carry out cognitive tasks. 'However, it is difficult to measure small changes in cognitive function or to separate the emotional effects of having cancer from the physical effects caused by chemotherapy.' Indeed, some studies have shown that people with cancer have cognitive impairment before they start treatment, suggesting it may be the cancer which is causing the problem, rather than the chemotherapy. 'It is one of those things that needs to be researched, but we will never get to the bottom of it,' says Professor Sikora. What medics do agree on is that they don't want to put people off having life-saving treatment. 'If chemotherapy is going to give you a long-term benefit, and small cognitive impairment is one of the risks, then it is a risk probably worth taking,' says Professor Sikora. Sue has no regrets about undergoing chemotherapy. 'I am very happy with my life now. I am free of cancer and that is the main thing.' But she is in no doubt that her brain has been adversely affected by her treatment. 'Everyone going through chemotherapy forgets things. At the time you talk and joke about it and think it will get better. And because you feel so unwell and are concentrating on just trying to get through the treatment, it doesn't have a huge impact on your life. 'However, once you finish chemotherapy treatment, people expect you to be better - but that is far from the truth. You try to do what you did before, but your brain just won't let you. 'It has changed my life totally. I moved job because I could no longer manage the demands of a senior managerial position.' She now works in a public library providing support and information to people with cancer. 'My earning capacity has reduced, and that has had a long-term impact on my life,' she says. The good news is that today patients are better informed about these kinds of side-effects. 'I was never warned there could be long-term side effects of having the chemotherapy,' she says. 'That's why it was such a shock. It is so much better if you are prepared.'

CHEMO BRAIN: COGNITIVE PROBLEMS MAY OCCUR EVEN BEFORE A CANCER PATIENT UNDERGOES CHEMOTHERAPY, STUDY FINDS
The thinking problems associated with cancer treatment -- often called "chemo brain" -- may sometimes be present before a person undergoes chemotherapy, according to a small new study. The research, presented at the American Association for Cancer Research and Cancer Therapy & Research Center's San Antonio Breast Cancer Symposium, suggests that chemotherapy may not be the sole cause for cognitive problems during cancer. Therefore, "women should not avoid accepting recommendations for lifesaving chemotherapy for fear of 'chemo brain,'" study researcher Bernadine Cimprich, Ph.D., R.N., who is an associate professor emerita at the University of Michigan School of Nursing in Ann Arbor, said in a statement. The study included 97 women; 28 with breast cancer who received chemotherapy, 37 with breast cancer who received radiotherapy, and 32 who didn't have breast cancer. Researchers had them report how much fatigue they felt, and they also conducted fMRI brain scans on the women as they completed a memory task (in order to see their neurocognitive responses) a month before they started their cancer treatment (if applicable), and a month after they started their treatment. Researchers found that fatigue levels were higher and accuracy on the memory task was lower among the women who underwent chemotherapy -- both before they started the chemotherapy and after -- compared with the women who underwent radiotherapy and the healthy women. The levels of fatigue reported were strongly linked with the performance on the memory test and later thinking problems. And before anyone received treatments, researchers found that the women with breast cancer had less functioning in the brain regions vital to performing the memory task than the healthy women. Specifically, the healthy women had the best functioning of this part of the brain, followed by the women who would go on to receive radiotherapy, followed by the women who would go on to receive the chemotherapy. "Our initial findings showed that the level of worry interfered with patients' ability to do a task," Cimprich said in the statement. "The level of worry had a key role in the cognitive problems with these women before treatment, and this worry was related to fatigue." Because the findings were presented at a conference and not yet published in a peer-reviewed journal, they should be regarded as preliminary. However, this isn't the first time it's been suggested that "chemo brain" symptoms may not only come from chemo. A study published earlier this year in the Journal for Clinical Psychology in Medical Settings showed that women who had breast cancer surgery but had not yet undergone chemotherapy experienced similar memory problems as those who had undergone the treatment. The study also showed that the women who were most likely to experience these problems were also the ones who were more stressed or didn't cope with their stress in a direct way, researchers found. And another previous study, published in the Archives of Neurology, showed that women who had survived breast cancer are more likely to experience thinking difficulties as evidenced by brain scans, with women who underwent

chemotherapy being more likely to experience these thinking problems at a greater severity than others, Health.com reported. "I have patients tell me, 'I'm just working harder and I'm slower at what I do, and I have to check my work and I still find errors, even when I'm working methodically,'" Robert Ferguson, Ph.D., who is a clinical psychologist at Eastern Maine Medical Center but who was not involved in the study, told Health.com. "This data is consistent with that anecdotal report."

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