Cognitive Side Effects from Mesothelioma Treatment

Most people are aware that cancer treatments can impair mental function like making the patient feel hazy or become forgetful.  What most people do not realize is that these cognitive impairments are part of a very real condition called chemo brain. In fact, in some people chemotherapy produces long term cognitive impairment and scientists still don’t know why.1

Until recently, it was generally believed that the cancer caused the cognitive impairment, but now many researchers believe it’s the result of drugs – specifically the chemotherapy drugs. Current research is testing animals to prove that drugs cause the impairment and that the right mixture of drugs containing antioxidants can prevent memory loss.

What is Chemo Brain? 

Chemo brain is any number or combination of cognitive side effects which may occur during cancer treatment. Most commonly, chemo brain involves forgetfulness and disorganization.  It is often described as a mental fog and can last as long as two years. Many patients are unable to concentrate, even for short periods of time.  In more drastic cases of chemo brain, patients may forget common words or lose their ability to adeptly perform tasks which they used to perform well.

Even though chemo brain is defined as “mild” cognitive impairment, it can still disrupt the lives of people dealing with it.  Patients may not be able to work, can forget appointments, or have difficulties with simple multitasking – like talking on the phone while writing a note.  Chemo brain can be dangerous if patients incorrectly take medications or if they make hazardous mistakes like forgetting to turn off the stove.

In most cases, the symptoms of chemo brain diminish after cancer treatment is stopped.  However, in approximately 20% of cases, chemo brain persists even well after the cancer treatments have stopped. One area of research is investigating whether the drugs that suppress the growth of cancer cells are also suppressing the functioning of healthy non-diseased neurons.3

What Causes Chemo Brain? 

Some experts currently believe that chemo brain is solely caused by chemotherapy as opposed to the cancer. Up to 75% of patients surviving chemotherapy will have chemo brain symptoms. However, researchers are still studying whether there are likely numerous other possible causes of chemo brain, including the cancer itself (as has been believed for many years) and other cancer treatments besides chemotherapy. In studies of chemo brain, researchers were surprised to find that patients had cognitive performances 20-30% lower than expected before they underwent chemotherapy.

It is very difficult to study the causes of chemo brain because almost all cancer patients undergo complex multimodality treatments. Additionally, the stress of coping with cancer could also result in chemo brain.  Other side effects of cancer and its treatment, like insomnia, malnutrition, infection, and hormonal changes, among other symptoms, could also factor into chemo brain symptoms.

Not all cancer patients will experience chemo brain.  New research from Dartmouth Medical School shows that certain patients may have a genetic predisposition to chemo brain.  The same gene which is associated with Alzheimer’s disease may increase the risk of chemo brain.  However, this research is still in its infancy.

Treatments for Chemo Brain 

There is no set treatment for chemo brain which isn’t surprising considering doctors still don’t agree on the cause. However, the symptoms of chemo brain can be controlled or alleviated using certain methods or medications. If you have problems with mental fuzziness or fog, it’s important to take steps to alleviate the problem as much as possible. Foremost, patients can first eliminate any factors which may contribute to chemo brain symptoms, such as by:

  • Getting enough sleep
  • Eating a healthy diet
  • Exercising (if approved by doctor)
  • Using stress-coping techniques
  • Treating depression

Patients are also encouraged to adapt their lifestyles to deal with chemo brain symptoms. This can include:

  • Keeping a regular schedule
  • Getting organized, such as by keeping a daily planner or other reminder system
  • Taking regular breaks
  • Doing cognitive exercises, such as crossword puzzles

It is important that cancer patients tell their doctors if they are experiencing symptoms of chemo brain.  Many patients simply assume that the symptoms are part of their treatment and there is nothing that can be done.  However, in some cases, there may be medications which can alleviate chemo brain symptoms.  Some medications used for treating ADHD, Alzheimer’s disease, and sleep disorders may be helpful in treating chemo brain. Alternative treatments such as ginkgo and Vitamin E may also help improve symptoms of chemo brain.

References

1 Fremouw, T., Fessler C. L., Ferguson, R. J. and Burquete, Y. Preserved learning and memory in mice following chemotherapy: 5-Fluorouracil and doxorubicin single agent treatment, doxorubicin-cyclophosphamide combination treatment (Jan 2012) Behav Brain Res, v226:1, 156-162.

2 Konat GW et al (2008). Cognitive dysfunction induced by chronic administration of common cancer chemotherapeutics in rats. Metabolic Brain Disease. DOI 10.1007/s11011-008-9100-y

3 Grace E. Jackson, Chemo brain – A psychotropic drug phenomenon?, Medical Hypotheses, Volume 70, Issue 3, 2008, Pages 572-577, ISSN 0306-9877, 10.1016/j.mehy.2007.06.019.