“CHEMOBRAIN” How to deal with the cognitive changes during and after treatments?

Breast cancer survivors often experience cognitive changes during and after systemic treatments, mainly chemotherapy ^[6,7].  Even though this topic has been undervalued for some time, it has been gaining more focus by the scientific and medical communities, driven by the increasing awareness of survivorship issues ^[5].  The pathophysiology of these cognitive changes is not yet fully understood ^[4].

It is estimated that 30% to 70% of cancer patients undergoing systemic treatments experience some kind of cognitive change ^[1,7], with most studies being conducted on breast cancer patients. However, the experience of these cognitive changes can be very different for each individual patient not only for the severity of symptoms but also for their duration. In most cases, patients report mild changes that last for a few months, but others present long-term complaints that impact their daily functioning, and quality of life and can be even perceived by the one’s around them ^[2,4,8].

The most frequent cognitive complaints^[3] are:

• Difficulty concentrating or focusing on tasks;
• Slower thinking and more time needed to learn and understand new information;
• Difficulty with multitasking;
• Trouble recalling or remembering common words or names, especially during conversations;
• Increased reaction time;
• Forgetfulness.

The cause of these cognitive changes is multifactorial, involving medical and treatment-related factors (type of treatment, duration of the treatment), psychological factors such as anxiety and depression, sleep disturbances, fatigue, and individual risk factors, such as age, comorbidities, and cognitive reserve ^[1,2].

Are you dealing with this or do you know someone who is? What should you do?

First, you should inform your doctor or the care team about these complaints. A referral to a neuropsychological assessment can be organized after the assessment of these complaints. Additionally, you can also use some strategies in your daily life that will help you cope with these difficulties ^[9]: 

• Use of compensatory strategies such as external memory aids [planners, lists, keep things in the same place];
• Do the most cognitively demanding tasks at the time of the day when energy levels are highest;
• Using relaxing and stress reduction strategies;
• Regular physical activity;
• Limit the use of alcohol or other substances that can affect cognition and sleep routine;
• Yoga and/or meditation;
• Exercise your brain by doing cognitively stimulating activities (e.g., reading books or magazines, practical activities like gardening, visiting places, playing musical instruments, and artistic activities, among others).
• Talk to somebody and alert them about how you are feeling.

In case of severe or persistent cognitive difficulties, confirmed by the neuropsychological assessment, a cognitive training program or psychotherapy can be offered to improve with proven efficacy ^[9].

References

¹ Ahles, T., Root, J., & Ryan, E. (2012). Cancer- and Cancer Treatment–Associated Cognitive Change: An Update on the State of the Science. Journal Of Clinical Oncology, 30(30), 3675-3686.

² Ahles, T., & Root, J. (2018). Cognitive Effects of Cancer and Cancer Treatments. Annual Review Of Clinical Psychology, 14(1), 425-451.

³ Asher, A., & Myers, J. S. (2015). The effect of cancer treatment on cognitive function. Clin Adv Hematol Oncol, 13(7), 441-450.

⁴ Jean-Pierre, P. (2010). Management of Cancer-related Cognitive Dysfunction—Conceptualization Challenges and Implications for Clinical Research and Practice. Oncology & Hematology Review (US), 06, 9.

⁵ O’Farrell, E., MacKenzie, J., & Collins, B. (2013). Clearing the air: A review of our current understanding of “chemo fog.” Current Oncology Reports, (3):260-9.

⁶ Vannorsdall, T. (2017). Cognitive Changes Related to Cancer Therapy. Medical Clinics Of North America, 101(6), 1115-1134.

⁷ Wefel, J., & Schagen, S. (2012). Chemotherapy-Related Cognitive Dysfunction. Current Neurology And Neuroscience Reports, 12(3), 267-275.

⁸ Vannorsdall, T. (2017). Cognitive Changes Related to Cancer Therapy. Medical Clinics Of North America, 101(6), 1115-1134.

⁹ NCCN®. Version 2.2019, 06/05/19 © 2019 National Comprehensive Cancer Network®.