I Need Treatment For Cancer Can I Prevent Chemo Brain
Your healthcare providers choose the treatments that they expect will kill or slow your cancer. They know some of those treatments may affect your memory and your ability to concentrate. Theyll work with you to reduce those side effects as much as they can while effectively treating your condition.
Are there risk factors that increase the chance Ill have chemotherapy brain fog?
Healthcare providers have found a few risk factors, most of which you cant control. For example, age and underlying medical conditions may increase your risk of developing chemotherapy brain fog before, during or after receiving cancer treatment.
Investigating The Effects Of Chemotherapy On The Brain
Cancer-related cognitive problems are estimated to affect more than half of cancer survivors. There are currently no FDA-approved medications to treat cognitive problems linked to cancer treatment, and research examining the molecular mechanisms responsible for them has been limited.
For many years, Dr. Salveminis research has studied chemotherapy-induced pain in the hands, feet, and other extremities, known as peripheral neuropathy.
Her teams studies of rats showed that chemotherapy drugs alter levels of S1P, which transmits signals linked to important activities within the pain system. Their previous studies also linked pain with high levels of S1P in parts of the central nervous system. Dr. Salvemini and her team wondered if an increase in S1P might partly explain the cognitive issues often linked with chemotherapy.
In the new study, the researchers treated healthy mice with a cisplatin protocol similar to one that is used in humans. Two weeks after receiving the last dose, many of the mice struggled to complete a battery of behavioral tests for cognitive function , while mice given a placebo had no such problems.
The researchers then analyzed areas of the mouse brains that are important for cognition. As in their pain studies, the researchers found that levels of S1P had increased in these areas after cisplatin treatment, which caused other brain changes, including inflammation, that have been linked to cognitive impairment.
Researchers Say The Brain Inflammation In Long Covid Is Similar To That In Cancer Patients
People with chemo brain and covid brain fog could not seem more different: Those with chemo brain have a life-threatening disease for which theyve taken toxic drugs or radiation. Many of those with covid brain fog, in contrast, describe themselves as previously healthy people who have had a relatively mild infection that felt like a cold.
So when Stanford University neuroscientist Michelle Monje began studies on long covid, she was fascinated to find similar changes among patients in both groups, in specialized brain cells that serve as the organs surveillance and defense system.
It was really quite striking, Monje said.
In cancer patients undergoing treatment, a malfunction in those same cells, known as microglia, are believed to be a cause of the fuzzy thinking that many describe. Scientists have also theorized that in Alzheimers disease, these cells may be impeded, making it difficult for them to counteract the cellular wear and tear of aging.
Monjes project is part of a crucial and growing body of research that suggests similarities in the mechanisms of post-covid cognitive changes and other long-studied brain conditions, including chemo brain, Alzheimers and other post-viral syndromes following infections with influenza, Epstein-Barr, HIV or Ebola.
We are not starting from nothing, she said, and I think thats very hopeful.
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Chemobrain: Its Not Your Imagination
Scientists discussed the mechanisms of chemotherapy-related cognitive impairment at a session dedicated to symptom science at the AACR Annual Meeting 2021.
Image by apagafonova
If youve found yourself referring to newfound forgetfulness or a momentary lapse in memory as chemobrain after your chemotherapy, youre not alone. As many as 75% of cancer patients who receive chemotherapy report some change in cognitive performancea condition known as chemotherapy-related cognitive impairment. While most of the symptoms improve after treatment, between 20% and 30% of patients experience persistent cognitive problems, some for up to 20 years, according to research presented at an educational session on symptom science at the American Association for Cancer Research Annual Meeting 2021, held online April 10-15.
There is a subgroup of people who consistently report difficulties returning to their daily activities, both at home and work, said Catherine M. Bender, a nurse-scientist at the University of Pittsburgh School of Nursing, who presented her findings on cognitive dysfunction at the meeting. They report that they need more time and more effort to perform their usual activities, and they experience increased frustration and decreased quality of life.
A Deeper Dive Into Cognitive Decline
Combating Brain Changes
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The Chemo Drug That Disrupts Brain Cells
In the recent study, the researchers focused on three important types of cell that are present in the brains white matter. These are:
- Oligodendrocytes. These generate and protect myelin, which is the substance that insulates axons. Axons are the fibers through which nerve cells communicate with one another.
- Astrocytes. These help keep the neurons well-irrigated, and they maintain a healthy environment for these cells, allowing them to communicate properly.
- Microglia. These are specialized immune cells that normally destroy any foreign agents that may be harmful to the brain.
When the scientists compared frontal lobe brain tissue collected postmortem from children who had received chemotherapy with tissue from children who had not, they saw that the former presented significantly fewer oligodendrocyte lineage cells.
To understand why oligodendrocytes were not doing well in the chemotherapy-exposed brain, the researchers turned to young mouse models that they injected with methotrexate.
They aimed to replicate the dosage and practice performed in human cancer treatment, so they gave the mice three doses of the drug once per week.
After a period of 4 weeks, the mice that received methotrexate had sustained damage to their oligodendrocyte precursor cells, which are the fresh cells that normally develop to replace oligodendrocytes that can no longer function.
Some of these effects also persisted for 6 months following treatment with methotrexate.
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Is It Possible To Reverse ‘chemo Brain’
Healthline/Medical News TodayDec 12, 2018
Chemotherapy can affect a person’s brain for years after coming to an end. How does it actually change the brain, and is there anything that scientists can do to reverse these effects?
Many people who undergo chemotherapy will notice cognitive impairment and behavioral changes. This might include difficulty with movement.
Some people refer to this effect as “chemo brain.”
It can last for months or years, impacting people’s quality of life following cancer treatment.
Researchers at Stanford University School of Medicine in California recently conducted a study to find out exactly how and why chemotherapy agents affect the brain, and to see whether or not there is any way to block or reverse that effect.
The resultswhich appear in the journal Cellappear to indicate that methotrexate, a common chemotherapy drug, affects the normal functioning of three important types of cell present in the brain’s white matter.
Chemo brain’s impact
The scientists also report learning that a drug currently undergoing clinical trials for other uses can address these ill effects in a mouse model.
“It’s wonderful that alive, but their quality of life is really suffering,” claims lead study author Erin Gibson. “If we can do anything to improve that, there is a huge population that could benefit,” she notes.
“Cognitive dysfunction after cancer therapy,” explains senior study author Dr. Michelle Monje, “is a real and recognized syndrome.”
Targeting Neuroinflammation And Glial Cells
Neuroinflammation remains a significant risk factor for neurodegeneration and can be targeted at both the peripheral and central levels. Several largescale studies have examined the effects of overthecounter nonsteroidal antiinflammatory drugs such as aspirin, ibuprofen, and naproxen on preventing or treating AD. However, the results are highly mixed, ranging from beneficial, to neutral, to harmful . Drugs approved for treating multiple sclerosis, a disease characterized by excessive inflammation and bloodbrain barrier disruption, work through actively suppressing the immune system. Examples include copaxone, rituximab, and cladribine, which target T cells and B cells, and natalizumab, which blocks the migration of immune cells across the bloodbrain barrier . Because these drugs are associated with serious side effects including systemic immunosuppression and liver damage, the risks may outweigh the benefits of reducing mild cognitive impairment in chemobrain.
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When Do Cognitive Changes Occur
Cognitive changes can occur at any point during your experience with cancer. Sometimes they are the first sign of a brain tumor. These changes may also happen after completing cancer treatment or after taking certain medications.
- Chemo brain can occur during or after chemotherapy treatment.
- Delirium may occur suddenly during treatment. Delirium usually happens after an identified cause, such as chemotherapy, and it is often reversible.
- Dementia due to cancer treatment comes on gradually over time and usually after treatment is completed. It may be harder to identify than delirium, and it may not have one identifiable cause. Dementia can develop as early as three months after radiotherapy to the brain. It can also occur 48 months or longer after completion of radiation therapy.
- Symptoms of dementia can also occur after surgery to remove a brain tumor.
How Do I Take Care Of Myself
First, treat yourself with patience and gentleness. Theres nothing easy about cancer and cancer treatment. You may need time to recover physically, mentally and emotionally from the challenges of having cancer and coming through cancer treatment, including chemotherapy. Here are some suggestions that may help you cope with chemo brain:
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Cognition And Cancer Treatment
Psychologists and oncologists are developing tools and techniques to better diagnose and treat cancer-related cognitive impairment
Vol. 51, No. 2
Monitor on Psychology51
Every year more than 650,000 cancer patients in the United States receive chemotherapy. During their therapy, some of them experience confusion, lapses in memory and attention, and difficulty concentrating, a collection of symptoms known colloquially by patients as chemo brain or chemo fog and more formally by clinicians as cancer-related cognitive impairment. This phenomenon has been studied most extensively in breast cancer patients, and different studies find from 15% to 75% of patients report experiencing it. Most fully recover within a year, but 20% to 35% continue to experience symptoms for months to years after their chemotherapy ends .
Studies consistently find that this impairment can undermine a persons quality of life, yet for many it is so subtle that it is undetectable by oncologists, as well as close friends and colleagues. So far, treatment options, mostly consisting of medications, cognitive skills training and exercise, havent offered much relief. But now, research supported in large part by the National Cancer Institute is identifying risk factors and developing diagnostic tools and treatments.
Treatment Of Chemo Brain
Treatments for chemo brain may include:
- Cognitive rehabilitation: This might be part of a cancer rehabilitation program. It includes activities to improve brain function such as learning how the brain works and ways to take in new information and performing new tasks doing some activities over and over that become harder with time and using tools to help stay organized such as planners or diaries.
- Exercise: Exercise can improve your thinking and ability to focus. Activities such as gardening, caring for pets, or walking, can help improve your attention and concentration levels.
- Meditation: Meditation can help improve brain function by increasing your focus and awareness.
Talk to your cancer care team about these treatment suggestions and other options they may recommend to help you cope with any cognitive problems.
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To test this idea, Monjes team used a model developed by Iwasaki at Yale to infect mice with a mild form of Covid-19 that was limited to the airways. They also studied brain samples taken from nine people who had died of Covid-19. And Putrino, who works with patients in Mount Sinais Center for Post-COVID Care, had been collecting serum samples from people suffering from long Covid with or without cognitive impairment. The scientists found high levels of cytokines and chemokines proteins that regulate immune responses as well as signs of microglial reactivity in the brains white matter that mirror what appears in the brains of people after chemotherapy. One particular chemokine linked to cognitive impairment was higher in people experiencing long Covids brain fog than in people whose long Covid didnt include cognitive symptoms.
Monje wasnt surprised to find this similarity, but she did find it quite striking. It was not subtle, she said. She credits advances made in the fundamental understanding of how neurons and glial cells work with each other to maintain neuronal health and plasticity. That basic work is going to really hopefully inform the cognitive function after Covid, she said. Whats exciting about that is were not starting from ground zero.
At long Covid clinics, which have sprung up in every state but North and South Dakota in the U.S., symptom relief is the mainstay to treat the array of persistent problems spanning the body and mind.
Looking For Potential Solutions For A Growing Challenge
Finding ways to treat or prevent cognitive impairment after cancer treatment is a complex problem because many more factors are at play than just chemotherapy treatment, Dr. Minasian said. These factors include age and other health problems, as well as considerations like socioeconomic status and stress levels.
Age is an important consideration, Dr. Janelsins agreed, especially as the aging population grows and advances in cancer treatment lead to more long-term cancer survivors.
Considerations for adults who may have a preexisting vulnerability to cognitive decline or preexisting cognitive impairment will become increasingly important when trying to make decisions about cancer treatment, she said.
This is why Dr. Salvemini is excited to gain a better understanding about ways to address this complex issue.
We want to look at not only if can we prevent cognitive impairment , but if we can treat and improve it, she said. may not be 100%, but even if we can improve it by 20% or 30% that could have a major impact on somebodys life.
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What Causes Chemo Brain
Chemotherapy drugs target rapidly proliferating cells, aka cells that multiply quickly. This is because cancer cells replicate more quickly than most of the cells in your body. But some cells proliferate more quickly than others for example, your skin, eye, and hair cells.
Since most chemotherapy agents are not able to focus exclusively on cancer cells, they will kill some of the other cells in your body, too. Chemotherapy is effectively one big gamble that the drugs will kill the cancer cells faster than your healthy cells.
Unfortunately, that means every part of your system can take a hit from chemo such as your vascular system, your blood-brain barrier, and all your organs. Hair cells and eye cells may sustain heavier losses since they reproduce more rapidly than other cells its why many cancer patients lose their hair during treatment.
All the dying cells cause inflammation and other problems, which in turn affect cognitive function in over 60% of chemotherapy patients. Some experience chemo brain for only a short while, and others have it for years after their cancer treatment. There may be a connection between previous brain injury and developing the longer-lasting chemo brain symptoms more on that later.
What Is Chemo Brain
Most define it as a decrease in mental sharpness and describe it as being unable to remember certain things and having trouble finishing tasks, concentrating on something, or learning new skills. Even though its exact cause isnt known, it can happen at any time when you have cancer.
These mental changes can make people unable to perform usual activities like school, work, or social activities. Or it can seem like it takes a lot of mental effort to do them. Many people don’t tell their cancer care team about their problems until it affects their everyday life. It’s important to get help and support, so be sure to let your cancer care team know if you notice any mental changes, no matter how small.
Here are some examples of what patients with chemo brain may experience:
- Forgetting things that they usually have no trouble remembering
- Trouble concentrating
- Trouble remembering details like names, dates, and sometimes larger events
- Trouble multi-tasking, like answering the phone while cooking, without losing track of one task
- Trouble learning new things
- Taking longer to finish things
- Trouble remembering common words
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That can mean a neuropsychiatric evaluation along with cognitive rehabilitation, which uses exercises to help patients with processing speed as well as memory and attention. Sometimes stimulants can help, especially if brain fog and fatigue come together.
Whats next for Monjes research is to build on the basic science. Questions to answer could include how vaccination affects the inflammatory response to mild Covid, Stevens of Boston Childrens said, and whether early childhood exposure to Covid influences brain development, and could therapies for chemo brain help people recover from Covids brain fog.
Monje said its too soon to talk about any treatments.
I dont want to speculate about what therapies might be useful because I cant recommend anything we havent tested, she said. We will be testing potential interventions first in preclinical models and then there will be carefully controlled clinical trials so that we can identify the best and safest. But I wouldnt want people to think, Oh, I read somewhere that x y z, you know, calms down microglia. Ive seen that happen on Twitter.
Meanwhile, she suspects because infection with the Omicron variant is milder for vaccinated and boosted people that might limit long Covid. She certainly hopes so. She and most of her family tested positive for Covid-19 after a distressing six-hour plane ride home from holiday celebrations back east.