Chemo patients' memory loss is real, studies reveal
By Tara Parker-Pope
WALL STREET JOURNAL (source: Contra Costa Times)
Posted on Sat, Apr. 10, 2004
For years, chemotherapy patients who complained of memory problems -- or so-called "chemo brain" -- were told it was all in their head. But new research shows that chemo brain is real.
Although cognitive complaints following chemotherapy have often been written off to depression, anxiety and even menopause, doctors now know that chemotherapy can trigger real, and sometimes lasting, changes in a patient's brain.
Last week, researchers from UCLA presented imaging studies at a scientific meeting in Orlando, Fla., showing marked differences in the brains of breast cancer patients who had undergone chemotherapy compared with patients who had undergone surgery alone.
Studies are just beginning on whether certain drugs or cognitive therapy can help prevent or offset that side effect. Some patients are given the stimulant Ritalin, which can help improve concentration.
Not every patient develops cognitive problems after chemotherapy, but enough people do that more and more doctors are beginning to warn patients about the potential side effect, says Eric Winer, director for breast oncology at the Dana-Farber Cancer Institute in Boston.
Most of the problems typically relate to focus, fast thinking, organization skills and an inability to multitask.
The problem has been most studied in breast cancer patients, in part because many of those patients are relatively young and highly educated and have high survival rates.
That makes cognitive declines more noticeable compared with declines in older or retired patients. But cognitive problems also have been noted with other cancers, including lymphoma and lung cancer.
Much more research is needed to say conclusively how widespread the problem is. Studies of breast cancer patients show that nearly two-thirds of women treated with chemo develop some level of cognitive problems, though most recover on their own in the weeks or months after treatment stops.
Still, as many as 20 percent to 25 percent of patients may develop lasting problems, says Tim A. Ahles, program director of the center of psycho-oncology research at Dartmouth Medical School, which has led much of the research on the subject.
For patients, the simple acknowledgment that their complaints are real has been a long time coming.
Houston resident Janis Shea, a nurse and former college professor, says that after undergoing chemotherapy for breast cancer, she began having trouble finding words and balancing her checkbook. Even her sense of humor was off.
She recalls a friend telling a joke about shoes made from bananas. The punch line, "slippers," was lost on her.
"Everybody was laughing, but I just didn't get it," she says. "I used to teach and lecture to 200 people and I was having trouble putting sentences together."
Shea attended a support group and discovered other women were hesitant to talk about the problems out of fear it would jeopardize their careers or because their doctors didn't think the problem was real.
Shea's complaints prompted her husband, a physician at the University of Texas M.D. Anderson Cancer Center, to discuss the issue with colleagues, who began research into the problem as a result.
But studying the ailment is tough. Some of the symptoms, such as short-term memory problems and loss of verbal fluency, can also happen during menopause, when estrogen production begins to plunge.
Many breast cancer patients are in the midst of menopause or thrown into it by the treatment. Memory problems also are associated with depression and fatigue, both common problems among cancer patients.
However, brain images show that in some people chemotherapy can trigger distinct changes. At UCLA, researchers studied the brains of breast cancer patients who complained about cognitive problems after chemotherapy -- comparing them with women with breast cancer who didn't receive chemo.
In the women who had undergone chemo, the images showed differences in metabolic activity in the parts of the brain involved in language; some parts of the brains of chemo-treated woman looked 25 years older than they were.
Knowing that real changes have taken place in the brain actually has helped many women cope, says Dan Silverman, head of neuronuclear imaging at UCLA. "They say, 'Now I know I'm not crazy,'" he says.
In studies at M.D. Anderson, patients were given neuropsychological assessments both before and after chemo, and about 60 percent showed significant cognitive decline after treatment.
It's important to note that even though the problems are frustrating, they typically are subtle and manageable, says Christina Meyers, professor of neuropsychology at M.D. Anderson, where several studies are under way.
Meyers says the neuropsychological tests can reassure patients by ruling out Alzheimer's, and help them better understand whether the problem is related to chemo, depression or other issues.
Researchers at Dartmouth University are studying "cognitive rehabilitation" for chemo patients, focusing on compensation strategies, such as writing detailed notes or using a hand-held organizer, as well as relaxation techniques, because cognitive problems increase with stress.
At M.D. Anderson, some patients take Ritalin to help them focus, but researchers also are studying whether giving the anemia drug Procrit before chemo can prevent cognitive damage.
For patients who need chemo, the problems aren't significant enough for them to turn down treatment. But doctors say patients who are borderline candidates may want to factor the potential cognitive side effects when deciding whether to undergo chemotherapy.