Fitch MI, Armstrong J, Tsang S.
Patients’ experiences with cognitive changes after chemotherapy.

Can Oncol Nurs J. 2008 Fall;18(4):180-92.  PMID: 19580104 [PubMed – indexed for MEDLINE]

Being diagnosed with cancer and undergoing treatment can be a daunting experience. The side effects of treatment often influence a person’s quality of life. One side effect that has been identified more recently is known as “chemobrain.” Although attempts have been made to quantify and measure cognitive changes, little attention has been paid to describing the changes from the patient’s viewpoint. This investigation was undertaken to understand the impact of cognitive changes on daily living and to identify the strategies patients used to cope with “chemobrain.” Thirty-two individuals provided in-depth interviews about their experiences living with cognitive changes. Their descriptions provided clear evidence that the changes could effect daily living, social and work-related activities. About a quarter of the individuals expected the changes to be temporary while the rest were uncertain or expected the change to be permanent. The emotional distress people experienced was linked to whether or not the cognitive changes interfered with their doing something that was of importance to them. Overall, participants used a variety of strategies to cope with the changes. The most frequently identified strategy was “writing everything down.” When asked what nurses could do to assist them in managing this side effect, participants emphasized how important it is for them to have information about the potential for cognitive change at the beginning of their treatment.

  Whitney KA, Lysaker PH, Steiner AR, Hook JN, Estes DD, Hanna NH.

Is”chemobrain” a transient state? A prospective pilot study among persons with non-small cell lung cancer.

J Support Oncol. 2008 Sep-Oct;6(7):313-21.PMID: 18847074 [PubMed – indexed for MEDLINE]

In patients with stage III non-small cell lung cancer (NSCLC), chemotherapy combined with radiation therapy modestly improves survival when compared with radiotherapy alone. In light of the small survival benefit,there is a need to quantify any potential loss of neurocognitive function that may result from chemotherapy in this patient population. The current study examines cognitive functioning in 14 stage III NSCLC patients who received treatment with cisplatin/etoposide/radiotherapy. Patients were assessed before receiving chemotherapy and at 1 and 7 months after treatment. At each time point, participants were administered a comprehensive battery of psychological and neuropsychological tests. In all, 71% of patients demonstrated cognitive impairment prior to any treatment. One month post chemotherapy, the majority of patients (62%) experienced cognitive decline; however, these negative effects apparently dissipated by 7 months post treatment, suggesting that the untoward effects of chemotherapy in these specific patients given this chemotherapy regimen may have been transitory. Cognitive decline did not appear to be associated with age, mood, fatigue, or quality-of-life measures. These findings demonstrated the importance of employing both a pre- and extended post-treatment assessment in chemotherapy research.

  Weiss B.

Chemobrain: a translational challenge for neurotoxicology.

Neurotoxicology. 2008 Sep;29(5):891-8. Epub 2008 Apr 9. Review.PMID: 18479752 [PubMed – indexed for MEDLINE] 

Neurotoxicity is a frequent accompaniment of cancer chemotherapy, and held by many oncologists to be the major dose-limiting side effect. It appears in many forms, but attracted attention during the past decade primarily because of complaints by patients of impaired cognitive function they have labeled as “chemobrain”. Neuropsychological testing confirmed the validity of these complaints and has generated a substantial literature examining different aspects of cognitive impairment in various clinical populations undergoing a variety of treatments. Cognitive impairment is far from the only manifestation of neurotoxicity induced by chemotherapy, however. It alters sensory function and motor function as well. A critical need for patients is a suite of methods that will enable clinicians to trace the onset and progression of neurotoxicity so as to guide and balance decisions about the course of chemotherapy. This commentary describes some of the potential methods and encourages neurotoxicologists to enlist their unique skills in the service of these needs.