FRIDAY, Dec. 7 (HealthDay News) -- So-called "chemo brain" --
problems with thinking, concentrating and remembering that are
associated with receiving chemotherapy -- may actually start to
occur before the treatment is initiated, a small new study
In the new study, pre-treatment mental fog and fatigue were
associated with thought-process problems (also called "cognitive"
problems) that have previously been assumed to be directly related
to the treatment.
"It's hard not to believe that chemotherapy could damage the brain, but we found evidence of the problems occurring in many women even before the therapy had begun," said lead author Bernadine Cimprich, associate professor emerita at the University of Michigan School of Nursing.
Cimprich said previous studies on the mental effects of
chemotherapy have offered a range of conclusions, but she felt none
fully answered key questions about the cause of the mental fog and
fatigue, and the timing of those problems. She and her colleagues
wondered whether the stress of anticipating chemotherapy and
treatment could be responsible for at least a portion of the
"Our study isn't saying chemo brain doesn't exist but that there are other factors that may make women vulnerable to it and may compound the impact," Cimprich said.
The research was scheduled to be presented Friday at the San
Antonio Breast Cancer Symposium. Because this study was presented
at a medical meeting, the data and conclusions should be viewed as
preliminary until published in a peer-reviewed journal.
Chemotherapy involves treatment with cancer-killing drugs that
may be given intravenously (injected into a vein) or by mouth. It
is given in cycles, with each period of treatment followed by a
recovery period, and treatment usually lasts for several
The researchers tested 97 women, including 65 who had localized
breast cancer and 32 healthy women without cancer. The women with
cancer had all had surgery, while 28 were going to receive
chemotherapy and 37 were going to receive radiation therapy. Before
treatment and a month after treatment was begun, the participants
performed a verbal memory task during functional MRI brain imaging
and reported on their fatigue levels.
Women who underwent chemotherapy performed less accurately on
the mental task tests both before treatment and after treatment.
They also reported a higher level of fatigue.
Why did the women anticipating chemotherapy show a greater
incidence of chemo brain than did those who were awaiting radiation
therapy? "Anticipation of toxic side effects may increase the
burden of distress," Cimprich said.
"It's a big decision for a lot of women, especially when they have a choice [of whether to have chemotherapy or not]," she explained.
Cimprich said the research is encouraging because it suggests
that early intervention may reduce or even prevent thought-process
problems in women who will be getting chemotherapy. "It opens up
the paradigm of attack. If the problems were only caused by the
chemotherapy, there wouldn't be much we could do to prevent them,"
There are probably multiple sources of the thought-process
difficulties women with breast cancer experience, Cimprich said,
including worry and concern about the prospect and potential impact
Cimprich said there are several things health care providers can
do to help eliminate the problems, including being aware that these
issues can begin before treatment. She added that it is important
that care providers understand that women awaiting chemotherapy are
more vulnerable to thought-process problems related to chemotherapy
and fatigue. "We may be able to identify women at greater risk,"
Preventive treatment options, Cimprich said, include exercise
and activity, cognitive behavioral therapy and mindfulness therapy,
such as meditation.
Dr. Julie Gralow, a professor in the medical oncology division
of the University of Washington School of Medicine and director of
breast medical oncology at the Seattle Cancer Care Alliance, said
the study was well done and will change the way she talks with
women with breast cancer facing treatment after surgery.
Gralow said that when she's warning women about the potential
issues associated with chemotherapy, she'll be sure to say, "You
may already be experiencing some of this now."
Learn more about chemotherapy for breast cancer from the
American Cancer Society.
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