Taking Steps to Cope With Chemo Brain

New York Times

Jane E. Brody

August 10, 2009

Link to Article


The Fog That Follows Chemotherapy

New York Times

Jane E. Brody

August 3, 2009

Link to Article

Check the Consults blog, “When Cancer Treatment Affects Memory,” where Dr. Daniel Silverman, a leading researcher in the field and co-author with Idelle Davidson of “Your Brain After Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus,” is answering questions.

Volunteers Sought for “Chemo Brain” Study

Posted Date: 7/16/2009

Dr. Patricia GanzResearchers at UCLA’s Jonsson Comprehensive Cancer Center are seeking volunteers recently treated for breast cancer who may be experiencing cognitive difficulties, a condition often referred to as “chemo brain.”

The pilot study aims to develop and evaluate a rehabilitation program for breast cancer survivors who believe they are having trouble thinking and concentrating after receiving treatment. Study volunteers will be asked to come to UCLA for a 90-minute initial baseline visit, then return once a week for six weeks to participate in two- to three-hour group intervention sessions. Volunteers will need to return to UCLA for one-hour follow-up visits two months and six months after the intervention.

‘Women with ‘chemo brain’ often can’t focus, remember things or multitask the way they did before their breast cancer treatments. They can be overwhelmed with day-to-day life,” said Dr. Patricia Ganz, director of cancer prevention and control research at UCLA’s Jonsson Comprehensive Cancer Center and principal investigator of the study. “They can’t recall phone numbers or where they put their keys. The group intervention program is designed to address these concerns, to provide tools and techniques to aid with memory and focus.”

Ganz and her team are seeking 25 volunteers to participate in the study, which is funded by the Breast Cancer Research Foundation.

To find out more about the study, call (310) 825-2520.

UCLA’s Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation’s largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2009, the Jonsson Cancer Center was named among the top 12 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 10 consecutive years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.


VABION Launches New Chemo Brain eBook Guide

PRLog (Press Release) – May 14, 2009 – For_Immediate_ Release

United States of America (News Release) May 14-  Richmond, VA based

VABION LLC (VABION) announced today that that VABION chief executive and chief scientist Susan Hardwicke, Ph.D. has completed an eBook on chemo brain, and that the book is now available online.  Dr. Hardwicke is a specialist in cognitive skills and neuro-nutrition whose experience in recovering from chemo brain inspired the creation of a program designed to help consumers and professionals.  Chemo Brain and Recovery: A Guide to Survival presents the program.
“While many in the research community debate about how to measure the effects of chemotherapy on the brain, many thousands of cancer survivors are suffering from chemo brain impairment,” said Dr. Hardwicke.  “I know: I was one of them,” she continued.
Chemo brain symptoms range from memory impairment, attention and focus problems, language difficulties, slower processing speed, and motor control.  Many patients with chemo brain report feeling as though they are in a fog and cannot clear it.  According to Dr. Hardwicke, who has examined brainwaves on electroencephalograph (EEG) systems, the fog has a measurable correlate in higher slow wave activity and reduced alert states.   The difficulties associated with chemo brain can be reduced and nearly eliminated with specific, symptom-specific strategies.
“When professional advice about chemo brain is provided,” Dr. Hardwicke states, “it consists of a list of very general activities, such as solving crossword puzzles, making ‘to do’ lists, and engaging the support of family and friends.”   Research and practice from clinical neuropsychology, cognitive neuroscience, and nutraceuticals provide tools to recover from chemo brain.  “In a way similar to physical therapy for stroke victims, chemotherapy patients can rewire their brains and feel more like themselves after chemo brain,” Dr. Hardwicke added.
Dr. Hardwicke experienced and largely recovered from memory impairment, speech difficulties, and decision-making as a result of chemotherapy treatments for breast cancer.  The brain’s characteristic of neurogenesis, which is the capacity to grow new cells, as well as proper nutrition and mental exercise, can alleviate many concerns from chemo brain.
For additional information on chemo brain, or to learn more about the book, visit the company’s website at http://www.vabion.com/ Chemo_Brain.html.

“Chemo Brain” Disturbing to Breast Cancer Patients

Highlights from the Oncology Nursing Society’s 10th National Conference on Cancer Nursing Research
Held February 12-14, 2009, Orlando, Fla

ORLANDO, FLA—For the more than 2 million breast cancer survivors in the United States, improved treatments have prolonged life at the cost of some unpleasant side effects. Among them, the cognitive changes known as “chemo brain” may be the most upsetting.

“Cognitive dysfunction is a significant problem,” affirmed Diane Von Ah, PhD, RN, an assistant professor in adult health at the Indiana University School of Nursing, estimating that the problem affects up to 83% of breast cancer patients. “It’s prevalent, bothersome to women, and can be potentially debilitating and impact their quality of life.”

Dr Von Ah told meeting attendees that because the etiology of cognitive dysfunction is not known, the condition is difficult to treat. However, she suspects there are a number of underlying factors, and researched the relationship between serotonin and “chemo brain” based on the direct relationship between the neurotransmitter and estrogen. Estrogen withdrawal is a consequence of breast cancer treatment.

The double-blind, placebo-controlled, crossover trial employed acute tryptophan depletion therapy. Because tryptophan is a precursor to serotonin, alterations in tryptophan levels will affect serotonin. The intervention group received a higher dose of an amino acid to deplete tryptophan compared to the control group (100% vs 25%). Participants completed neuropsychological testing 5 hours after administration of the amino acid, at the tryptophan nadir. Women in the intervention group were depleted 85% by hour 5, and the control had a 49% reduction in tryptophan. Twenty women completed the study.

“We did not find a significant impact on short-term memory, but we did in long-term memory,” said Dr Von Ah. The team also found changes in motor function in the dominant and nondominant hands during the tryptophan depletion, but no significant changes to attention, concentration, executive function, or information processing speed.

The responses did not vary for antiestrogen use, antidepressant use, treatment protocols, or genetic factors. There were no significant differences in mood or blood sugar between the groups.

“In our study, we found that serotonin may be involved in memory consolidation and psychomotor ability,” stated Dr Von Ah. “We need to do further research to fully understand the protective role of serotonin in cognitive dysfunction, so we can do more with potentially novel treatment therapies, either pharmacologically or behaviorally through diet.”

Dr Von Ah presented a second study in which she investigated self-reported cognitive dysfunction and quality of life in African-American and Caucasian breast cancer survivors in a descriptive, correlational study of secondary data from a larger quality-of-life study. The sample included 134 women (46% African American and 54% Caucasian) 1-10 years postdiagnosis.

More than 1 in 4 survivors (26%) reported poor attention, indicating that cognitive dysfunction can continue long after treatment. Deficits in capacity to direct attention correlated with poorer quality of life, including more depressive symptoms, lower sense of overall wellbeing, less social support, lower parental satisfaction, poorer physical functioning, and greater fatigue. Younger women had more attention problems, depression, and fatigue. African-American women had decreased social support and decreased levels of physical function. Women with increased comorbidities had increased depression, increased fatigue, and decreased well-being.

“Capacity to direct attention was related to poorer quality-of-life outcomes, suggesting interventions may have a broad impact on quality of life in breast cancer survivors,” summarized Dr Von Ah.

Joyce Thielen, PhD, RN, CS, associate director of undergraduate studies at Elms College in Chicopee, Mass, said women undergoing breast cancer chemotherapy frequently report changes in memory, executive function, organization, and multitasking abilities, yet subjective testing often does not correlate with the degree of severity patients are indicating. She conducted a qualitative study to better understand 13 women’s experiences and what it meant to them. She found the cognitive changes often were insidious and the women many times blamed them on menopause, lack of sleep, or early Alzheimer’s disease.

“They looked inside for answers to the attention problems they were having,” Dr Thielen explained.

The women reported an inability to read or to “keep their eye on the ball,” or had trouble working. The women also indicated difficulty driving or correctly taking medications. Family support helped them cope. They reported that nurses and doctors dismissed their cognitive complaints.

“It’s important to discuss side effects with patients and families,” Dr Thielen said. “The assessment needs to be at time of initial treatment and ongoing to pick up subtle changes that may develop.”

Dr Thielen also encouraged educating nursing students as well as nurses about “chemo brain” and the inclusion of neurocognitive measurements in clinical trials.

Catherine Jansen PhD, RN, OCN, an oncology clinical nurse specialist at Kaiser Permanente Medical Center, San Francisco, investigated cognitive function prior to chemotherapy, whether it changes over time, and its relationship with anxiety, depression, fatigue, anemia, menopausal status, and the patient’s perception of cognitive functioning. The prospective trial included 71 women receiving Adriamycin (doxorubicin) and cyclophosphamide (AC) or AC followed by a taxane. Participants completed multiple validated tests.

Preliminary results showed no significant changes in immediate memory, language, attention, executive function, and motor skills. However a significant effect of time was found for visuospatial skill, attention, and delayed memory. Significant changes in cognitive function remained when researchers controlled for anxiety, depression, fatigue, and hemoglobin levels.