Lifting the Fog on Chemobrain

New research helps clarify what chemobrain is and why it happens. 

Ever since he was a child, Adam Holloway wanted to be a pilot. He was well on his way in spring 2010. Holloway received his private pilot’s license the previous July and was only a semester away from earning a degree in aeronautical technology at Kansas State University Salina—the final step before earning a commercial pilot’s license.

Then in March 2010, while on spring break at his family’s home in McAllen, Texas, he received a diagnosis of stage 4 Hodgkin lymphoma, a cancer of the lymphatic system. He was treated with surgery at M.D. Anderson Cancer Center in Houston. Then he received chemotherapy, supplemented with an experimental treatment, SGN-35, on a clinical trial.

The chemotherapy worked, and Holloway’s cancer went into remission. But sometime in the midst of his 12 treatment cycles of chemotherapy, Holloway lost his mental focus and began having trouble with short-term memory.

"I seemed to forget stuff that had happened," Holloway says. "Usually I'm pretty good at remembering names of people. I found myself saying, 'Sorry, I forgot your name.'"

Holloway’s mother, a nurse who has worked with oncology patients, was the first person to suggest that he might have chemobrain, an ill-defined disorder experienced by some cancer patients who have struggled with cognitive function. “I was having trouble thinking of something, and my mom was joking with me that it’s chemobrain,” he recalls. “That’s how I learned about it.”

No Joking Matter

While patients have been telling their oncologists about unexpected difficulties with word recall, memory and concentration for years, most doctors were hesitant to acknowledge the condition. It took decades for research on chemobrain to gain traction, says Tim Ahles, PhD, a behavioral psychologist who leads the neurocognitive research lab at Memorial Sloan-Kettering Cancer Center. Ahles says investigators have had a tough time applying science to cancer patients with such a range of cognitive complaints and diverse diagnoses. In addition, patients often suffer from accompanying problems, such as anemia, pain, depression and other illnesses that can affect brain function. 

Christina Meyers, MD, PhD, director of the neuropsychology section at M.D. Anderson, says cognitive dysfunction related to cancer treatment has become a burgeoning area of investigation, one where patient advocacy has helped move the research forward. “When I started at M.D. Anderson, I was just a lone person giving memory tests to people who had cancer,” she reflects. That was 26 years ago. 

Meyers says that cognitive function issues are seen in survivors “across the board.”  She has seen it in patients with leukemia, lung and testicular cancers. She estimates about 60 percent of patients she has assessed show a cognitive decline. “Often the patients look really good, but it’s a huge effort. The mental cost to function at that level is very taxing,” she adds.

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