Sometimes physicians focus on the tangibles—nausea, vomiting, diarrhea, fevers—and it can be easy to forget to mention chemobrain. But it is something oncologists should counsel their patients on.
—Serena Wong, MD
The concept of “chemobrain” is underrecognized, noted Serena Wong, MD, co-investigator of a clinical trial examining the effects of chemotherapy and hormonal therapy on the brain. Dr. Wong is a medical oncologist at Rutgers Cancer Institute of New Jersey and Assistant Professor of Medicine at Rutgers Robert Wood Johnson Medical School, New Brunswick.
Many patients report symptoms associated with the condition commonly known as “chemobrain,” but “don’t know that is a phenomenon, a syndrome that has been named,” Dr. Wong said. “Patients will say, ‘I’ve been having trouble with short-term memory, word finding.’ And I will tell them, ‘Yes, this is a phenomenon called chemobrain.’ Then they are sort of relieved, because they think, ‘Oh, I thought it was just me. I’m so tired all the time.’ They chalk it up to having been through a lot of stress over the previous year, with the diagnosis, or to factors such as anemia, fatigue, and anxiety. Maybe that is a big component. It is hard to tease apart. But we have to think: What is our therapy doing?”
If patients aren’t familiar with chemobrain, should physicians proactively bring up the topic with women receiving or about to receive chemotherapy for breast cancer? “I think they should,” Dr. Wong said. “Sometimes physicians focus on the tangibles—the nausea, the vomiting, the diarrhea, fevers—and it can be easy to forget to mention something like chemobrain. But I do think it is something oncologists should counsel their patients on,” Dr. Wong advised. “However, the fear of possibly developing cognitive difficulties, which are usually relatively modest and tend to improve with time, should not deter someone from accepting potentially life-saving therapy.”
The goal of the study is to find ways to minimize or even prevent the effects of chemobrain. While awaiting those results, “There are certain things that we recommend to patients right now, which could potentially help them,” Dr. Wong told The ASCO Post. “Being proactive is a good approach.”
Depression and anxiety can be confounding factors. “Certainly, if someone is particularly depressed or anxious, we would recommend that they receive treatment for that,” Dr. Wong advised.
“If patients are having sleep disturbances, we recommend that they see a sleep specialist, or we could prescribe sleep aids. However, the caveat with sleep aids is that they are also sedative, and so we have to use them with caution and make sure that we use the lowest effective dose,” she added. “Sedation in itself can contribute to some cognitive dysfunction,” she noted, and some antinausea medications can also be a bit sedating.
“Regular exercise is certainly something that I think is quite helpful. And sometimes, there are medications, such as modafinil, which is used in shift workers to help increase attention and memory. “I don’t prescribe that personally that often,” Dr. Wong said, “but there are some early data suggesting that it could be helpful in this situation. Referral to a neuropsychologist can be very helpful as well if a patient is having particularly troublesome or persistent symptoms.” ■
Disclosure: Dr. Wong reported no potential conflicts of interest.
The novelty of our approach is that we are going to be using multiple modalities” to study the effects of chemotherapy and hormonal therapy on the brain, looking for structural changes within the brain and how these changes might affect psychomotor function, particularly upper-extremity movements...