Written by Dr. Keith I. Block, MD
We all have “those” moments. When, in mid-sentence, we lose our train of thought. Or, we put down our car keys and run for the phone, forgetting where we left those keys just minutes later. Generally, we laugh these moments off, attributing them to a lack of sleep or simply being too busy. However, for cancer patients, these moments may be far more profound and more distressing, and are usually attributed to what oncologists refer to as “chemobrain.” This is because one of the unfortunate side effects of many chemotherapy drugs is damage to the nervous system, including the brain, which can result in mild cognitive impairment (chemobrain). People who complain of chemobrain may experience memory lapses or problems remembering names or other things they previously had no trouble recalling. They often seem unable to find the right words to finish a sentence. They may seem easily distracted, unable to focus on what they’re doing, have trouble multi-tasking, take longer than usual to finish tasks, or seem disorganized and have trouble learning new skills.
Studies of patients receiving chemotherapy before being evaluated for cognitive function have unveiled a number of insights about the nature of chemobrain, and why some people are more prone than others. First, one’s cognitive reserves or intellectual ability prior to starting chemotherapy may help lessen the decline in mental functioning that occurs after treatment. Second, older patients are more likely to experience a sharper cognitive decline after chemo. Most studies of chemobrain have not included older patients, and yet 60% of all cancer survivors are older than 65 years, according to a 2007 Institute of Medicine report. Clearly, more research is needed to find ways to protect elderly patients from chemobrain. In addition, research may ultimately demonstrate that chemotherapy is not the only factor in the “brain fog” so many cancer patients experience. A recent study published in the September 5, 2010 issue of Supportive Care in Cancer, focused on the issue of whether cancer itself might contribute to cognitive problems.
Researchers from Kaiser Permanente Medical Center in San Francisco assessed 71 women prior to chemotherapy (doxorubicin and cyclophosphamide), a week after completing the last cycle of chemo, and six months after the completion of all chemo treatments. After receiving chemotherapy, there were significant decreases in attention, delayed memory, motor function, and visual-spatial skills. Most of these problems were generally short term or acute, not long-term chronic effects.
However, the study also found that 23% of the women had cognitive impairment prior to starting chemotherapy, suggesting that the disease itself was causing some cognitive problems. We now know that other factors linked with invasive cancer, such as elevated levels of pro-inflammatory chemicals (cytokines), may contribute to poorer cognitive functioning in people with cancer – independent of any effect of chemotherapy.
Strategies for preventing chemobrain or “cancer brain” – a term that acknowledges the effects of the disease itself – should seek to include and target these inflammatory chemicals. One such strategy would be to use the herb gingko biloba, which improves circulation and helps prevent early dementia by producing anti-inflammatory cytokines. Dietary changes can also reduce inflammation in the brain. Diets high in vegetables and fruits are known to lower the risk of dementia while omega-3 fatty acids (found in cold water fish such as salmon) are known to provide important anti-inflammatory effects.
Impressive reductions in chemobrain have been seen with the drug called modafinil (Provigil). Also dubbed the “genius pill” and traditionally used to treat sleep apnea, modafinil increases wakefulness and seems to boost brainpower without causing the jittery feelings induced by amphetamines. In a controlled trial of 68 women who had completed treatment for breast cancer, all women took the drug for four weeks. During the next four weeks, half of the women continued to receive the drug while the other half took a placebo pill. Women taking modafinil for all eight weeks reported significant improvements in memory, concentration and learning, as reported in the June 15, 2009 issue of Cancer.
Other more holistic strategies are also being explored to address the symptoms associated with cancer and chemo brain. Examples include meditation, cognitive rehabilitation and an active focus in improving coping strategies with the goal of enhancing working memory. Working out your brain is not unlike exercising the body – that is, over time you either use it or lose it! Speaking of exercise, keeping physically active could further help mitigate the signs of chemobrain.
The “cancer rehab” program at the Block Center combines several integrative strategies – including prescriptive exercise, therapeutic diet, selective supplementation, and stress-care strategies. These are wrapped into an individualized, comprehensive program in an effort to not only combat chemobrain, but to help patients restore their physical, emotional and biological strength both during and after the completion of their treatment program. For most of our patients, the symptoms of chemobrain have either disappeared or greatly improved within six months to a year of completing treatment.
For more information on The Block Center for Integrative Cancer Treatment, visit BlockMD.com.