SAN ANTONIO—Researchers suggested at the CTRC-AACR San Antonio Breast Cancer Symposium that chemo brain may have more to do with fatigue and the stress of receiving a breast cancer diagnosis than with the chemotherapy drugs used in treatment.
“There is a need for increased clinical awareness that cognitive problems can begin before any adjuvant treatment,” said Bernadine Cimprich, PhD, RN, Associate Professor Emerita at the University of Michigan School of Nursing.
She and her colleagues performed functional magnetic resonance imaging on breast cancer patients before they underwent treatment, and those brain scans showed reduced function in frontal regions of the brain that are needed to perform the “working memory task” when compared with controls, she said.
When the women were followed over the course of their treatment, these women who were less able to activate frontal brain regions needed for the task before treatment suffered greater fatigue over time, regardless of their type of treatment, Cimprich said.
“Women awaiting chemotherapy were more worried and more fatigued than controls. Across all groups, greater fatigue was associated with poorer test performance, and more reported cognitive problems over time.”
The NCI-funded study included 28 women treated with chemotherapy, 37 who received radiation therapy, and 32 healthy women who acted as controls. But even the healthy women were weighed down by problems of daily living, Cimprich noted—job loss, deaths of relatives, and other “vicissitudes of daily living.” Adding a breast cancer diagnosis and treatment on top of that adds to cognitive problems, she suggested.
“Chemo brain” may thus be an inaccurate descriptor of cognitive issues, she said, adding that fatigue is a key contributor to cognitive problems and that interventions to reduce stress and fatigue may alleviate postchemotherapy neurocognitive problems.
“Women faced with the decision to undergo chemotherapy should know that cognitive problems, should they occur, may not always stem from chemotherapy,” Cimprich said. “Women should not avoid accepting recommendations for lifesaving chemotherapy for fear of ‘chemo brain.’”
She recommended existing interventions to combat stress after a breast cancer diagnosis, including mindfulness intervention, psychological support, cognitive behavior interventions, and exercise. “It might be possible to diminish worry and fatigue and maintain strong brain function during the course of treatment using these interventions,” she said.