Pill” May Relieve Chemobrain
June 5, 2007
The researchers looked at the effects of Provigil, a drug used to treat excessive sleepiness from certain sleep disorders, in 68 women suffering from chemobrain, also referred to as chemo fog. Chemobrain is mild cognitive impairment characterized by the inability to remember certain things, complete certain tasks, or learn new skills.
“After just four weeks of treatment, we saw improvements in their ability to recall,” says researcher Sadhna Kohli, PhD, MPH, a research assistant professor at the University of Rochester’s James P. Wilmot Cancer Center. “Those who continued taking the drug for eight weeks saw improvements in attention,” she tells WebMD.
Kohli stresses that the results have to be replicated in more women and for longer periods of time before Provigil should be prescribed for chemo brain, however.
The findings were presented here at the American Society of Clinical Oncology’s annual meeting.
For years, many doctors doubted the existence of chemobrain, although many people with cancer complained of problems with memory, concentration, and attention skills during and even after treatment with chemotherapy drugs.
But “it’s increasingly being acknowledged as a real phenomenon for some patients,” says Ann H. Partridge, M.D., PhD, a cancer doctor at Dana-Farber Cancer Institute in Boston. She was not involved in the study.
In a separate study last year, Kohli and colleagues found that 82 percent of 595 people with cancer given chemotherapy reported problems with memory and concentration.
“Some of them say it would resolve very quickly after treatment ended; some say it lingers for years,” Kohli says.
Since people with chemobrain find it very hard to pay attention, the deficits can lead to job loss and social problems, she says.
The new analysis looked at whether Provigil, designed to promote wakefulness among those with sleep disorders including narcolepsy, would help relieve symptoms and improve mental function. Provigil seems to boost brainpower without causing the jittery, restless feelings induced by amphetamines, Kohli explains. It stimulates the brain only when it is required, with effects dissipating in about 12 hours. As a result, sleep-deprived college students, athletes, soldiers, or others who want to gain an edge in a competitive environment sometimes seek out the drug, calling it a genius pill.
In the study, 68 women who had completed chemotherapy treatment for breast cancer were given the drug for four weeks. Then, for another four weeks, half of the women continued to receive the drug while the others were given a placebo pill.
The women were given a series of cognitive tests before starting the drug, at four weeks and at eight weeks. For example, they would be asked to watch a series of pictures or words flashed on a screen and then asked to recall them five minutes later. Results showed that after just four weeks, women could recall faster and more accurately recognize words and pictures. By eight weeks, attention deficits improved and memory was even better.
Since Provigil does not linger in the body, side effects are minimal, according to Kohli.
“This is a very provocative and exciting study,” Partridge tells WebMD. “Chemo fog can hamper some people’s lives for a long time, if not forever. I hope to see confirmatory findings soon.”
By Charlene Laino
Reviewed by Louise Chang, M.D.
© 2007, WebMD Inc. All rights reserved.
This Is My Brain on Chemo
May 14, 2007
Medical researchers have decided there really is such a thing as “chemo brain.” But I did not need a stamp of authenticity from someone in a white coat to believe in it. I live with it. I know it’s real.
Among cancer patients, “chemo brain” refers to both the immediate and the long-term effects of chemotherapy. I started chemotherapy in the fall of 2005. At the end of my first round, I was in a thick fog. Simply scheduling my next appointment was difficult for me. Two older women who were also patients at the cancer clinic kindly offered an explanation for my fumbling mind: “You have chemo fog.” Among the more experienced cancer patients, this was a well-known phenomenon.
The chemotherapy I was given for breast cancer was an aggressive, “dose dense” regimen that left my brain scrambled after each session. Even after the worst of each round’s side effects passed, I remained in a haze of sorts, with difficulty thinking clearly. Arguably, the shock of being diagnosed with cancer, the disorientation of being suddenly yanked out of a normal, healthy life and thrown into the world of life-threatening disease — the Big C variety no less — could be responsible for my mental lapses. But that degree of difficulty had to have an organic source.
Months after my chemotherapy treatments were concluded and the worst of the fog had faded, I was distressed to realize that I was still not functioning at full capacity. First, I became aware of gaps in my memory. People would mention an event or conversation that I had been party to and I would have absolutely no memory of it. I was reminded of the movie “Memento,” in which the main character has lost the ability to store anything in short-term memory. When he met someone new he would take a photo of them and write their name on it because he knew that by the next day he would have no recollection of having ever met them.
I have no way of predicting what I will remember and what I will forget. It isn’t really the same as ordinary memory lapses — forgetting one thing from a long list or forgetting something because you were distracted and not really paying attention when it happened. I think I am paying attention, but … poof! No memory of whatever I was supposed to do, no recollection of a conversation or event. And it is usually so completely erased that I am initially incredulous. “I already told you? Are you sure?”
My medical team — and believe me, with cancer you get doctors, lots and lots of doctors — is not particularly concerned about my mental symptoms. Their first concern, of course, was stopping the cancer from killing me. Having successfully removed all evidence of the tumor, they turned their attention to preventing any remaining cancer cells from spreading or forming a new tumor. My prognosis is now very good. My oncologist is not unsympathetic to any of my post-treatment problems, physical or mental, but faced with so many other patients whose prognosis is much worse than mine, I imagine she has difficulty getting too worked up about my forgetfulness.Yet the leaks in my short-term memory continue, and they are only one aspect of the chemo brain that afflicts me more than a year after my last chemotherapy treatment. One of the most frustrating and noticeable problems has been difficulty finding the right word. Of course, this “tip of the tongue” phenomenon afflicts everyone from time to time. But the problem for me is not the occasional inability to recall a word; rather it is the quite frequent inability to name common objects. I look at that thing on the table, but for the life of me I cannot tell you what it is called. “Book.” “Envelope.” “Cup.” Words I taught my son when he was a toddler, he must now supply for me when I am completely incapable of finding them in my chemo-altered brain
My ability to focus and concentrate is also in disrepair. In my professional life, I research demographic and economic issues and write reports and articles. Not being able to get my thoughts in focus or maintain my concentration has made that very difficult. I have had to find ways to compensate, such as minimizing distractions and doing the most difficult tasks at a time of day when I’m at my sharpest. I sometimes feel as if I just cannot get a mental grip on anything — as if my thoughts are a swirling jumble of nonsense.
Lately I have noticed some improvement. My need to work has more or less forced me to relearn how to maintain concentration in the face of distractions and interruptions. The inability to recall words also seems to be a less frequent occurrence, perhaps because writing provides me with practice in this area. My memory, on the other hand, is not much improved. Rather, I have learned to ask people to give me a gentle nudge from time to time if I have promised to do something, just in case I have forgotten. I am making the sorts of accommodations I imagine people have to make when they are developing Alzheimer’s or have damage to a certain area of the brain.
I hope I will fully return to my old self, but just as I cannot know for sure that the cancer is gone forever, so do I not know how closely I will ultimately be to the person I was before I was diagnosed with cancer.
I try not to complain much about chemo brain. For one thing, I have other, more debilitating problems that overshadow it. Not being able to come up with a word is relatively minor compared to the pain I feel in my feet when I step out of bed each morning, a lingering effect of chemotherapy. The sometimes excruciating joint pain I experience thanks to the tiny tablet I take every day to (hopefully) rid my body of any remaining cancer cells has a far more profound impact on my quality of life than my Swiss-cheese memory. Not being able to shed the more than 30 pounds I put on during my treatments is certainly depressing, and the extreme — and extremely frequent — hot flashes that have curtailed many of my activities are perhaps the worst of all. There is also the challenge of coming to terms with losing my breast and learning to live with a reconstructed substitute; I am lucky to have benefited from the skills of a great surgeon, but he could not give me back the nerves that once allowed me to have feeling in that part of my body.
It is also hard to complain when you consider the alternative. Cancer is fatal, after all, and it is these treatments, with all their nasty side effects, that make it possible to survive this nasty disease. But grateful as I am for a prolonged life, I cannot help but wish for my old self back. The physical and mental changes have left me struggling with some of the most basic elements of my identity. I do not look, feel or think quite as I did before. And frankly, I liked the old self quite a bit more than this overweight, achy and forgetful one.
As more of us survive cancer, I would not be surprised if our post-treatment problems spawned a new branch of medicine. There will certainly be a demand for it, because however grateful we are for the treatments that battle cancer, I cannot imagine that many of us will quietly accept being left with a much diminished self, particularly those of us who are members of the boomer generation. If we can overcome cancer, surely we can overcome almost anything else.
– By Susan Mitchell
Chemotherapy Fog Is No Longer Ignored as Illusion
New York Times
April 29, 2007
New Research Sheds Light on “Chemobrain”
Harvard Women’s Health Watch
Many people undergoing chemotherapy complain of problems with memory, attention, and concentration — a phenomenon called “chemobrain” or “chemo fog.” When we first wrote about chemobrain in October 2002, most of what was known of it came from the anecdotal reports of patients, often breast cancer survivors, and a few studies linking chemotherapy (but not surgery or radiation) to cognitive problems.
Researchers suggested potential explanations, including the sudden chemotherapy-induced onset of menopause, multiple medications — perhaps in combination with age-related changes in the brain — or brain damage from high doses of chemotherapy drugs. Subsequent research has shown that not all chemotherapy recipients have trouble with mental function, but for those who do, the effect can last several years. Thus far, a physiological explanation for chemotherapy-related cognitive trouble has remained elusive. But two studies may help fill in the gap.
Japanese researchers used magnetic resonance imaging to show that cancer drugs can cause temporary shrinkage in brain structures involved in cognition and awareness (Cancer, Jan. 1, 2007). The brain imaging was performed on three groups of women: breast cancer survivors who had received chemotherapy, breast cancer survivors who had not undergone chemotherapy, and a healthy control group. Compared to the other women, the chemotherapy recipients had less white matter (information-transmitting cells) and gray matter (information-processing cells) in regions of the brain involved in attention, planning, judgment, remembering, and self-awareness. Shrinkage in these areas correlated with generally lower scores on measures of attention, concentration, and visual memory. The encouraging news for women receiving chemotherapy is that within three years, follow-up scans showed no differences among the three groups.
The second study, by scientists at the University of Rochester Medical Center, found that three cancer drugs (cisplatin, carmustine, and cytosine arabinoside) used for a range of cancers tend to be more toxic to healthy brain cells than to cancer cells (Journal of Biology, Nov. 30, 2006) — at least in laboratory cell cultures. In the lab setting, these drugs killed 70%-100% of brain cells — but only 40%-80% of cancer cells. Animal studies showed that such effects lasted for at least six weeks after treatment. The drugs harmed various types of cells, including neurons that contribute to signal transmission in the brain.
The University of Rochester team speculates that these cancer drugs may block new cell formation in the hippocampus, a brain structure essential to memory and learning. The researchers stress that no one should avoid chemotherapy because of these preliminary results. But they suggest that their findings offer a physiological explanation for chemobrain and could eventually lead to ways of protecting the brain during chemotherapy.