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CHEMOBRAIN: A Once Misunderstood And Misdiagnosed Phenomenon

For years, many chemotherapy patients have reported problems with memory, concentration and focusing attention. These problems were long thought to be the result of depression, anxiety, or other ailments unrelated to chemotherapy.

Recently, however, more attention has been drawn to this phenomenon as a side effect of chemotherapy. A movement has been underway to educate the public and the medical community about such side effects, a condition for which chemotherapy patients have adopted the term "chemobrain".

Chemobrain refers to changes in memory, attention, and abilities to perform various mental tasks as a result of receiving chemotherapy treatments. Symptoms include but are not limited to:

  • Inability to remember things
  • Difficulty concentrating and following directions
  • Trouble learning new things or forgetting how to do things you have done before
  • Mood swings or feeling agitated
  • Tiredness, inability to fall asleep
  • Confusion

New research shows that chemobrain actually describes an organic phenomenon. Doctors at UCLA recently presented scientific findings showing marked differences in the brains of breast cancer patients who had undergone chemotherapy compared with patients who had undergone surgery alone. The study was conducted among breast cancer patients, since they tend to be relatively young and highly educated, thus there is less of a chance that any cognitive deficiencies could be attributable to other factors.

According to the UCLA research, the brain images of the women who underwent chemotherapy showed differences in metabolic activity in the parts of the brain involving language. It was reported that some parts of the brains of chemo-treated women looked 25 years older than they were.

It is not clear how widespread the problem is, but studies of breast cancer patients have shown that nearly two-thirds of women treated with chemotherapy develop some level of cognitive problems. A study recently completed at the University of Texas M.D. Anderson Cancer Center showed that about 60 percent of chemo patients showed significant cognitive decline after treatment.

Doctors now know that chemotherapy can trigger real and sometimes lasting changes in a patient's brain.

Further studies are being conducted to determine whether certain drugs or cognitive therapies can prevent or offset this side effect. Ritalin has been used in the past to help improve concentration.

While for many the effects are temporary, as many as 20 percent to 25 percent of patients may develop lasting problems.

Researchers continue to study which chemotherapies may be more prone to this condition. They are also developing new ways to prevent or minimize its symptoms and improve quality of life, such as through "cognitive rehabilitation," which focuses on relaxation techniques and compensation strategies such as writing detailed notes.

Some important tips for chemotherapy patients exhibiting symptoms of chemobrain:

  • Do not allow an uninformed member of your medical team to state that chemobrain is a new area of study or that little is known about it.
  • Undergo an examination in order to rule out such other perceived causes of the symptoms such as Alzheimer's or depression.
  • Recognize that because the cognitive deficiencies are generally tolerable, the survival benefit of chemotherapy still outweighs the potential risks to memory or concentration.
  • Speak to your doctor about strategies that are right for you. Some tips include avoiding distractions, asking people to repeat information, using a daily organizer, posting reminders, exercise, managing stress, etc.

Roger G. Worthington (1/27/06)

Sources: Wefel et al. Cancer, June 21, 2004 online edition. Christina A. Meyers, PhD, professor of neuropsychology, University of Texas M.D. Anderson Cancer Center, Houston. Len Lichtenfeld, deputy chief medical officer, American Cancer Society. Bev Parker, hotline director, Y-ME National Breast Cancer Organization, Chicago. Steven Castellon, PhD, research psychologist, UCLA School of Medicine.

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