Older Chemotherapy Regimen for Breast Cancer Linked with Persistent “Chemo Brain”

Women who received CMF chemotherapy for breast cancer between 1976 and 1995 scored slightly lower than women with no history of cancer on tests of word learning, memory, and information processing. These results were published in the Journal of Clinical Oncology.?

Studies of “chemo brain”—the foggy thinking and forgetfulness that patients may experience after chemotherapy—have suggested that the condition often improves with time. Some patients, however, may experience persistent problems.?

CMF is a chemotherapy regimen that was once commonly used in the treatment of breast cancer. It involves a combination of cyclophosphamide, methotrexate, and 5-fluorouracil. ?

To explore long-term effects of CMF on cognitive function, researchers in Europe conducted a study among 196 breast cancer survivors who had been treated with CMF between 1976 and 1995. The cognitive function of these women was compared with the cognitive function of more than 1,500 women who had never had cancer.?????

The cognitive test scores of the women who had been treated with CMF were slightly lower than the scores of the women who had never had cancer. Scores were lower in the areas of word learning, memory, and information processing speed. ?The reduction in test scores among the CMF-treated women was comparable to roughly six years of age-related cognitive decline.?

Although CMF is given less frequently than in the past, it is still used in some patients.? It is not known how other chemotherapy regimens affect long term cognitive function.? For women who are experiencing subtle but persistent cognitive problems, coping strategies—such as developing systematic daily routines and preparing well for activities such as work or travel—may be helpful.????

Some people appear to be more likely than others to experience long-term cognitive problems after chemotherapy, and researchers are looking into the reasons for this.?

Reference: Koppelmans V, Breteler MMB, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. Journal of Clinical Oncology. Early online publication February 27, 2012.?

Posted March 1, 2012

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Some Evidence of Mild “Chemo Brain” in Breast Cancer Survivors

Breast cancer patients treated with chemotherapy are at risk for mild cognitive deficits (sometimes referred to as chemo brain) after treatment, according to the results of a study published early online in the Journal of Clinical Oncology. ?

A large portion of breast cancer patients will ultimately receive adjuvant chemotherapy. Patients undergoing chemotherapy have long complained of a phenomenon referred to as “chemo brain.” Chemo brain refers to changes in cognitive function, such as loss of memory and inability to think clearly or perform some daily functions. Thus far, researchers have not been able to pinpoint the cause of chemo brain, but studies are ongoing to evaluate brain structure and function in order to better understand the effects of chemotherapy on the brain.?

There is mixed evidence regarding the scope and duration of chemo brain. Many studies have not focused on the post-chemotherapy period and thus have produced little data regarding the long-term effects of chemotherapy on the brain. ?

Researchers from the Moffitt Cancer Center conducted a meta-analysis of 17 studies that included 807 patients previously treated with standard-dose chemotherapy for breast cancer. The goal was to evaluate cognitive functioning in breast cancer survivors more than six months after being treated with chemotherapy. The studies included neuropsychological tests categorized according to eight cognitive domains: attention, executive functioning, information processing, motor speed, verbal ability, verbal memory, visual memory, and visuospatial ability.?

The results of the analysis indicated that patients treated with chemotherapy had mild impairments in verbal ability and visuospatial ability compared to non-cancer controls. Cognitive impairment varied across survivors; however, the researchers reported that age, education, time since treatment, and hormonal therapy did not seem to have an effect on the observed cognitive deficits. ?

The researchers concluded that, on average, cognitive deficits in breast cancer patients who were previously treated with chemotherapy are mild and are limited to verbal and visuospatial abilities. They suggest that this information can be used to educate patients regarding the long-term impact of chemotherapy so that patients can develop interventions and modifications to cope with cognitive effects. Breast cancer patients who experience cognitive deficits may need to visit a neuropsychologist for evaluation and coping strategies. ?

Reference:?

Jim HSL, Phillips KM, Chait S, et al. Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. ?

Posted September 17, 2012

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