More than one third of all breast cancer survivors experience post-treatment cognitive issues, but researchers from UCLA are working on a new rehab program designed to help those women deal with and eventually overcome the condition known as “chemo brain”.
According to the university, an estimated one out of every eight females will eventually develop invasive breast cancer during their lifetimes, and 35 percent of those women will experience the mental fog of “chemo brain” once their treatments come to an end. This condition prevents them from completing day-to-day activities such as keeping a schedule or finding their car keys.
So just what is “chemo brain” and what is it about cancer treatment that causes these drastic changes to take place in a patient’s brain?
We asked Dr. Patricia Ganz, a Distinguished Professor Health Policy & Management and Medicine at the UCLA Jonsson Comprehensive Cancer Center, and the lead author of a new study published recently in the journal Psycho-Oncology.
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“This is something that we have been studying for about 15 years and still don’t have all the answers,” she explained to redOrbit via email. “We know that during cancer treatments (surgery, radiation, chemotherapy, hormone treatments) patients will complain of being mentally foggy. It is not clear if this is due to anxiety, lack of sleep or medications during this time.”
“For most [patients] it gradually subsides, but for those in whom it persists, it can limit their return to everyday activities, including work,” Dr. Ganz continued. “They complain of feeling that everything is mentally slow, that they cannot focus or pay attention when reading, are easily distracted and cannot organize or plan activities. They are not totally disabled, but just cannot function at the same high level that they did before the treatment.”
Clouded hypotheses
The professor explained that there have been several studies utilizing advance neuroimaging techniques that have documents brain changes as a result of breast cancer treatments, and that research conducted in the Netherlands comparing older females 20 years post-treatment show “many subtle changes compared to age-matched women” that received no such therapy.
“We do not know for sure how this occurs,” she emphasized. “Some drugs can enter the brain and cause problems, but mostly were are seeing changes that might be related to inflammation and the brain, and possibly vascular changes with chemotherapy. The science is ongoing.”
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While the cause of “chemo brain” may be unknown, Dr. Ganz and her colleagues have devised a way to help lessen the effects of this unusual phenomenon. They have tested a new five-week, two-hour group training session during which patients suffering from the condition were taught a series of different memory and attention-building strategies by a psychologist.
Helpful strategies
The program, UCLA explained in a statement, focuses on executive functioning and planning activities, or those things that people do in order to organize throughout the day. The intervention program also included homework and practice activities that were discussed at the sessions each week and were designed to improve the memory and cognitive function, the university noted.
For example, the women were given exercises on how to remember a to-do list, recalling which items to buy at a store, or selecting the type of food that should be served to party guests, said Dr. Linda Ercoli, an associate clinical professor of health sciences at the UCLA Semel Institute and the person responsible for developing the cognitive rehabilitation intervention program.
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Dr. Ercoli, a co-author of the study, added that the study participants were also given a series of real-life tasks to complete which would utilize the strategies they learned to improve their overall cognitive function. Previous research by Dr. Ganz had found a link between neuropsychological test performance and memory complaints in post-treatment, early stage breast cancer patients.
The researchers assembled a group of women who had complained of post-treatment cognitive issues, had them complete baseline testing and asked them to answer questions about their mood and their mental functioning. Of the women, 32 were randomly selected to receive the treatment (early intervention group) and 16 were placed on a wait list (delayed intervention group).
Each of them underwent thorough neurocognitive testing before being categorized, again after the initial five-week therapy sessions and a third time two-months later, the university said. Most also underwent resting EEG (brain wave) testing to measure changes during the study.
An effective biological way
Dr. Ganz and her colleagues found that the early intervention group reported improvement in memory complaints and test functioning, while the delayed intervention control group did not improve in either their cognitive complaints or test performance, UCLA noted. Furthermore, the intervention group showed continued improvement two months after the program’s completion.
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Dr. Ganz said that the brain wave pattern of intervention group actually normalized, and that she and her fellow researchers were hopeful that this approach could provide “an effective biologic way” to assess the cognitive impact of various cancer treatments in the near future. The next step is to have other researchers review and test this approach in larger groups of patients.
“As for all research, it needs to be repeated by others to determine if the findings can be duplicated,” Ganz explained. “In addition, we need to see if we can find out who is at risk for persistent cognitive difficulties early so we can try to prevent or reduce the occurrence. That is where my personal research is going – prevention!”
“I think the most important part of the study was that we were able to improve the function in these women and the brain changes on EEG went along with this,” added Dr. Ganz, whose work was funded by the Breast Cancer Research Foundation and the Jonsson Comprehensive Cancer Center Foundation. “This suggests these problems are reversible if patients can get help.”
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Feature Image: Thinkstock
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