Cognitive problems in women undergoing chemotherapy may not be treatment-related

Women undergoing chemotherapy who experience cognitive problems, commonly referred to as chemo brain, displayed alterations in neurocognitive responses prior to undergoing treatment. Pretreatment neurocognitive compromise and fatigue were key contributors to the cognitive effects that are often attributed to chemotherapy.

“For a long time, women undergoing treatment for breast cancer have reported cognitive problems such as trouble thinking clearly, remembering things, and carrying out jobs and other responsibilities, which we have attributed to chemotherapy or chemo brain,” said Bernadine Cimprich, PhD, RN, of the University of Michigan School of Nursing. “Research shows that these problems do occur in some women during chemotherapy, but we still do not understand what the underlying causes are.”

The investigators theorized that the mental demand and stress of a breast cancer diagnosis could play a role in these early cognitive problems. They tested neurocognitive responses using functional magnetic resonance imaging (fMRI) on 28 women who received adjuvant chemotherapy, 37 who received radiotherapy, and 32 healthy controls. Before treatment and 1 month after treatment, the participants performed a verbal working memory task with varying levels of demand for cognitive control during fMRI scanning. The patients also provided a self-report of fatigue.

Women who underwent chemotherapy reported a significantly higher level of fatigue and performed less accurately on the cognitive tests before treatment and 1 month after treatment. In addition, greater fatigue correlated with poorer test performance and more cognitive problems reported over time.

Brain imaging before treatment showed reduced function in regions needed to perform the task in both patient groups when compared with controls, with more compromise seen in women awaiting chemotherapy. Women who were less successful in recruiting the brain regions needed for the task before treatment were more likely to suffer greater fatigue over time, regardless of treatment group.

“Our initial findings showed that the level of worry interfered with patients' ability to do a task,” Cimprich said. “The level of worry had a key role in the cognitive problems with these women before treatment, and this worry was related to fatigue.”

Scores for cognitive testing from women who underwent radiation treatment fell between those of women who underwent chemotherapy and those of the healthy women.

“Women faced with the decision to undergo chemotherapy should know that cognitive problems, should they occur, may not always stem from chemotherapy,” Cimprich said. “Women should not avoid accepting recommendations for lifesaving chemotherapy for fear of chemo brain.”

Cimprich recommended existing interventions to combat stress after a breast cancer diagnosis, including mindfulness intervention, psychological support, cognitive behavior interventions, and exercise.

“It might be possible to diminish worry and fatigue and maintain strong brain function during the course of treatment using these interventions,” Cimprich said.

This research was presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, held December 4-8, 2012.
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