Cancer treatment side effect: Chemobrain

In the late 1990s, doctors began to pay attention to chemobrain, a term used by an increasing number of
patients to describe mental symptoms and side effects.

Since that time, chemobrain has become accepted as a legitimate,
diagnosable condition experienced by many cancer patients. We sat down
with Jeffrey Wefel, Ph.D., associate professor of
Neuro-Oncology and chief of Neuropsychology, to learn more.

What is chemobrain?

Chemobrain is a term used by patients to describe changes in their
thinking, or cognitive function. Depending on the person, “chemobrain”
may refer to forgetfulness, slower thinking, difficulty concentrating
or periods of mental confusion or “fogginess.” It’s difficult to
pinpoint an exact definition, but it generally describes a feeling
that “my brain is not working quite the same as it was before cancer.” 

What causes chemobrain?

When we look at cognitive changes in cancer patients, there are two
distinct groups. In the first, patients with brain tumors can have changes in cognitive
function due to the location of their brain tumor and treatments that
directly affect brain tissue.

However, “chemobrain” is often used to refer to cognitive changes
experienced by patients in the other group: those without cancer in
the brain. While the term “chemobrain” seems to directly blame the
problem on chemotherapy, we’ve actually found that cognitive
problems can appear before any treatment begins. Even if cancer is not
growing in the brain, it can still disrupt systems in the body that
end up affecting mental function. Some treatment, including certain
forms of chemotherapy, hormonal therapy and immunotherapy, can also cause cognitive
dysfunction, meaning they can directly or indirectly disrupt, damage
or alter normal brain function.

Does chemobrain get better with time?

For many patients, the symptoms of chemobrain improve over time,
though they may not go away completely. Some people may continue to
experience chemobrain symptoms long after they’ve completed their
cancer treatment.

How is chemobrain diagnosed?

At MD Anderson, chemobrain diagnosis
begins with a referral to our Neuropsychology team for evaluation. A
neuropsychologist will talk to the patient and the family to get a
full picture of the symptoms, including specific situations where the
symptoms get better or worse. The patient also takes a series of
standardized tests to measure their thinking skills.

The evaluation shows both strengths and weaknesses in thinking
skills. It also rules out (or may reveal) other diagnoses, such as
dementia, anxiety, depression or fatigue, all of which can also affect
mental function. The neuropsychologist then works with the patient to
develop a treatment plan tailored to address their symptoms and goals.

What treatments are available for chemobrain?

Stimulants or brain training may help some patients. Cognitive
strategies or healthy lifestyle changes, like improved sleep quality
and exercise, can also help. Because symptoms and personal priorities
vary from person to person, our treatment plans are highly
personalized as well. Read tips for coping with chemobrain.

How has chemobrain research changed in recent years?

Over the last 10 years, the number of publications on cognition and
chemobrain has tripled. We have confirmed that chemobrain is real. Now
we’re trying to better understand which patients have the highest risk
for developing chemobrain, what’s causing it and the most effective
treatment approaches to maintain brain health and maximize cognitive function.

We’re currently recruiting breast cancer patients for an NIH-funded
observational study that will follow patients
over several years. Our goal is to find biomarkers to understand who’s
at risk for chemobrain.  

Measures of cognitive function are also being incorporated into
clinical trials more often. In addition to studying how well a
particular therapy controls the cancer, we’re also monitoring how that
therapy affects a patient’s thinking skills, both in the short term
and into survivorship. One example of this is a study that showed that
we can help maintain cognitive function in patients receiving whole
brain radiation by adding a medication to their treatment.  

In the lab, we’re studying regenerative medicine and other
approaches to treat brain damage and restore cognitive function after
the brain has been damaged by cancer or cancer treatment.

What advice do you have for caregivers when a loved one feels
like they have chemobrain?

Sometimes caregivers aren’t sure why their loved one is experiencing
changes in thinking or behavior, how best to manage these changes and
if they will improve or worsen with time. It’s important for our
patients and their loved ones to know there are experts who can help
them understand these changes and provide treatment recommendations.

Ask your loved one’s MD Anderson
physician for a referral to Neuropsychology for evaluation of
chemobrain symptoms. This is the first step to diagnosing and treating
cancer-related cognitive changes.

Request an appointment at MD Anderson online or by
calling 1-877-632-6789.