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Cognitive problems may occur before chemotherapy begins
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SAN ANTONIO — Women with breast cancer frequently begin to complain about cognitive impairment before chemotherapy initiation, according to study results.
The findings may contradict some previous explanations of the phenomenon known as “chemo brain,” according to Bernadine Cimprich, PhD, RN, associate professor emerita at the University of Michigan School of Nursing.
“Despite considerable research effort up to this point, the problem still remains unexplained,” Cimprich said during a presentation. “Results of previous studies are mixed.”
Cimprich and colleagues hypothesized that fatigue resulting from the anxiety and stress of a cancer diagnosis may have a significant detrimental effect.
“Fatigue is a complex biological psychological function that can occur in a downward spiral over time,” Cimprich said.
The researchers used functional MRI to test brain function while patients worked on memory tasks before and 1 month after chemotherapy. Patients reported cognitive function and fatigue. The researchers compared the results with those from patients treated with radiation therapy but no chemotherapy, as well as with controls who did not have breast cancer.
“The most important finding here is that, before treatment, women showed reduced function in frontal regions needed to perform the working memory task in patients vs. controls,” Cimprich said. “Women who were less able to activate frontal brain regions needed for the task before treatment suffered greater fatigue over time, regardless of type of treatment.”
Women awaiting chemotherapy were more worried and more fatigued than controls, Cimprich said. Across all groups, greater fatigue was associated with poorer test performance and more reported cognitive problems over time, study results showed.
Clinicians should be aware that these problems can begin before treatment, and that women who are waiting for treatment to begin are vulnerable to cognitive dysfunction, Cimprich said.
“Chemo brain may not be an appropriate label for cancer-related cognitive dysfunction,” she said. “Women faced with the decision to undergo chemotherapy should know that cognitive problems, should they occur, may not always stem from chemotherapy. Women should not avoid accepting recommendations for lifesaving chemotherapy for fear of ‘chemo brain.’”
Early identification and interventions — including psychological support, exercise and cognitive behavior interventions — are crucial, she added.
“It might be possible to diminish worry and fatigue and maintain strong brain function during the course of treatment using these interventions,” Cimprich said.
For more information:
Cimprich B. Abstract #S6-3. Presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.
Disclosure: Cimprich reports no relevant financial disclosures.
Perspective
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William C. Jangro, DO
Many breast cancer patients experience cognitive problems during and after receiving chemotherapy. Although controversial, the term “chemo brain” has come to refer to the often subtle but impairing cognitive deficits that are thought to be related to chemotherapy. The opposing view is that these cognitive deficits are actually caused by multiple nonspecific factors and not necessarily chemotherapy. This study by Cimprich and colleagues suggests that, in some patients, cognitive impairment often attributed to chemotherapy may actually be due to factors that precede chemotherapy. More specifically, they report that fatigue was correlated with reduced cognitive performance over time. Further research in this area will benefit from the development of specific criteria for this phenomenon. Whatever the cause, clinicians should aggressively screen for symptoms that can impair a patient’s quality of life. A multidisciplinary treatment team is essential in addressing the biological, psychological and social factors that lead to distress in patients with cancer.
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