Finding Solutions for Chemobrain

Cognitive issues related to cancer treatment might finally have some answers.

BY KATHY LATOUR
PUBLISHED: DECEMBER 08, 2013
Cognitive impairment, chemobrain, chemo fog, cognitive dysfunction. Different words, same outcome: frustrated patients with muddled minds and frustrated clinicians with no answers. Diane Von Ah, assistant professor in the School of Nursing at Indiana University in Indianapolis, became interested in treatment- related cognitive impairment while working as a clinical nurse in the bone marrow transplantation field. For an article in the Clinical Journal of Oncology Nursing, she detailed the cognitive processes affected by this malady: attention and concentration, executive function, information processing speed, language, visual-spatial skill, psychomotor ability, learning, and memory.

Von Ah interviewed survivors of breast cancer as part of her doctoral dissertation, and reports they all said the same things: “I can’t remember. I am so frustrated when I can’t say what I want to. Forgive me for being so slow, but I have chemobrain. In social situations, I can’t remember people’s names. And, I can’t remember where I put things.”

What Von Ah recalls vividly from her interviews was the frequently repeated word frustration. She was also affected by the impact that cognitive impairment had on survivors’ lives and self esteem, which she believes has been overlooked by the medical community.

Early retirement, anger, depression and few solutions. Pharmacologic approaches have had spotty success because of the variety of causes of the disorder and medication side effects, leaving survivors with few options. Until now.

[Read "Pharmacologic Approaches to Cognitive Dysfunction"]

Creating New Brain Cells

Julie Barrow’s breast tumor was breaking through the skin when she began seven months of treatment in 2001 with dose-dense neoadjuvant chemotherapy (Cytoxan [cyclophosphamide], doxorubicin and 5-FU [fluorouracil]). While the treatment resulted in a complete pathological response, she found herself walking into rooms and not knowing why she was there. She says her brain shut down. She improved somewhat when treatment ended, and she tried to return to work managing a field office for a national marine sanctuary near her home in Half Moon Bay, Calif.

“I did community outreach and was part of a major planning effort,” she says. “If I had been doing it alone, I wouldn’t have been able to. It was the team that worked out what we were going to do.”

After receiving a second cancer diagnosis in 2005 in her other breast, Barrow was treated with carboplatin and paclitaxel every three weeks. She says she experienced cognitive dysfunction so dramatic, she couldn’t balance her checkbook, a task she performed easily prior to cancer treatment. She opted for medical retirement in 2006 at age 50.

Around the same time, Shelli Kesler, an assistant professor of psychiatry and behavioral sciences at Stanford University in Stanford, Calif., was researching cognitive and neurobiological effects of cancer and chemotherapy.

Exercise increases the number of cells, but many of these die after a few weeks. Cognitive training can drive those new cells to wire into the brain network and become functional.

Talk about this article with other patients, caregivers, and advocates in the Breast Cancer CURE discussion group.
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