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Treatments for cancer, such as chemotherapy, can cause unpleasant side effects like nausea, fatigue and hair loss. Chemotherapy, and cancer itself, may also cause mild cognitive impairments, including problems with thinking, memory, language skills, learning, and concentration. Chemotherapy-related cognitive dysfunction is known as “chemobrain” among cancer patients.
Chemobrain may be characterized by any of the following symptoms:
Although cognitive side effects may be subtle, chemobrain can be upsetting, frustrating and scary for those who experience it. Cognitive changes can interfere with your ability to function in important areas of your life.
Not everyone who undergoes chemotherapy will experience cognitive side effects. For those who do, the severity and duration of symptoms varies from person to person. Cognitive difficulties may be mild and only slightly noticeable, or very noticeable.
The severity of symptoms may depend on several factors, such as the dose and type of chemotherapy used, cancer diagnosis, age, stress level, and underlying medical conditions. Even people with the same cancer type who undergo the same chemotherapy regimes can experience different cognitive effects.
While chemobrain may occur at any point, it tends to occur more frequently during chemotherapy and shortly after chemotherapy is finished. Cognitive changes may happen suddenly (acute onset), or emerge slowly over time (gradual onset). For some, cognitive problems are brief and subtle, lasting anywhere from a few weeks to a few months after chemotherapy. Others experience long-lasting (chronic) mental changes that can last up to a year or several years after completing treatment. Generally, symptoms tend to improve over time.
Today it is common for oncologists to administer more aggressive, higher-doses of chemotherapy in combination with other treatments. Thus, as many patients become long-term cancer survivors, cognitive side effects like chemobrain become more common.
The causes of chemobrain are not clearly understood at this time. Since so many factors can affect cognitive function, this condition is difficult to measure. Cancer treatment, its side effects, and cancer itself are some factors that may contribute to the cognitive dysfunction associated with chemobrain.
The frequency and severity of cognitive changes associated with chemotherapy may vary with the type of medicine used, the dosage, the method of administration, and drug combinations. For instance, higher doses of chemotherapy may be related to greater cognitive difficulties.
Some researchers believe chemotherapy can affect the way your brain functions, although it is not completely understood how. One theory is that chemotherapy drugs circulating in the blood may be able to cross the “blood-brain barrier” (a membrane that surrounds the brain and protects it from toxins in the blood).
Researchers are using MRI and other technologies to identify which parts of the brain are affected by chemotherapy. Some findings have revealed smaller regions in the brain that are associated with memory. The assumption is that during chemotherapy, the brain may have a reduced capacity to process information, and thereby has to work harder to remember things.
Aside from chemotherapy, researchers are studying the role of other cancer treatments like radiation therapy, surgery, and immunotherapies (e.g., interferon), as well as adjuvant medications (e.g., steroids, anti-nausea medication, sedatives) in causing cognitive side effects.
Some researchers believe chemobrain is a byproduct of cancer treatment. For instance, chemotherapy side effects like anemia, cancer-related fatigue, and depression, may be the cause of cognitive problems like memory lapses and concentration difficulties.
Some patients may experience cognitive declines even before chemotherapy begins. Thus, researchers question whether chemobrain is then the result of the disease process itself, or the body’s response to fighting the cancer.
Other factors that may contribute to, or imitate, the cognitive dysfunction associated with chemobrain include:
Researchers continue to examine the causes of chemobrain, as well as what can be done to manage and prevent it. As more studies explore this issue, the exact cause(s) of cognitive changes will become clearer.
Over the years, cancer survivors have wondered why they had difficulty remembering things or concentrating on simple tasks. Clinical studies evaluating these changes were scarce and healthcare providers tended to dismiss their symptoms, believing chemobrain did not exist. Patients were left to feel that the cognitive changes they were experiencing were a figment of their imagination.
Today, the oncology community and researchers have begun to acknowledge chemotherapy-related cognitive dysfunction as a real phenomenon. For people living with cancer, the word “chemobrain” has become part of the language. The recognition that this is a real condition has brought relief to those who experience its unwanted effects.
As new treatments become available, and as cancer patients become long-term cancer survivors, the long-lasting effects of cancer and its treatment begin to surface. One of these potential side effects, chemobrain, can interfere with your ability to maintain a productive, fulfilling life.
Researchers are currently studying possible interventions for the cognitive impairment associated with chemotherapy. Medications for depression, attention-deficit hyperactivity disorder (ADHD), and dementia are being investigated for their potential to improve thinking and memory problems in cancer patients. Aside from pharmacologic interventions, other techniques may include behavioral strategies, lifestyle alterations, rehabilitation therapies, and counseling.
Since cognitive changes vary from person to person, an individual assessment is an important first step in ruling out other conditions and developing appropriate intervention strategies.
Just like with other side effects of cancer treatment, if you are experiencing symptoms of chemobrain, it is important to keep your healthcare team informed.
The following are some questions you could ask your healthcare team:
Problems with memory, thinking and concentration can be very frustrating. Aside from seeking help from your healthcare team, there are other steps you can take to help reduce the impact of these changes on your everyday life.
NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING ANY COGNITIVE DYSFUNCTION YOU MAY BE EXPERIENCING.
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