Nursing Notes

· Many women experience chemotherapy-induced cognitive changes in memory, attention, psychomotor speed, and executive functioning. 

· The cognitive changes are called “chemo brain” or “chemo fog,” a mental haziness that occurs during and shortly after chemotherapy.


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· Women with primary breast cancer may be at high risk for altered brain structure and function.

· Cognitive impairment could be associated with the stress, anxiety, and mood changes associated with the diagnosis of the cancer.


Breast cancer is one of the most common public-health problems, with an estimated worldwide incidence of 39 per 100,000 individuals annually.1 In 2011, it was predicted that over 230,000 women would be diagnosed with breast cancer, and close to 40,000 would die of this disease.2 As more breast cancer survivors are living longer post-treatment, there is a definite need to understand the long-term outcomes of adjuvant therapies, as well as the cancer itself. Bone-marrow suppression, malnutrition, and infection/fever are the most commonly associated adverse effects experienced with chemotherapy.3 The incidence of neurotoxicity, although less well known, is often associated with peripheral neuropathy and encephalopathy, which fall under the traditional definition of neurotoxicity 4

Many women experience chemotherapy-induced cognitive changes in memory, attention, psychomotor speed, and executive functioning. Some women refer to this as “chemo brain” or “chemo fog,” a mental haziness that occurs during and shortly after chemotherapy.5,6 Several neuropsychological trials have confirmed these chemotherapy-induced cognitive changes.7–10 The question remains as to whether or not these changes are associated with abnormal brain function. Deprez and colleagues were able to demonstrate a change in cognitive functioning and cerebral white matter integrity in 34 young, premenopausal women with early-stage breast cancer receiving chemotherapy.11 These women did not perform well on attention, psychomotor, speed, and memory tests as compared to their performance before the start of chemotherapy, and compared to healthy controls and women that did not receive chemotherapy. Chemotherapy-treated women had significant decreases in fractional anisotropy in frontal, parietal, and occipital white matter, whereas both control groups stayed the same.

Researchers have begun to question whether or not these cognitive changes are a direct result of chemotherapy, or from the cancer itself. Although primary breast cancer has not been historically associated with neurological problems, a growing body of evidence suggests that women with primary breast cancer may be at high risk for altered brain structure and function. These neurobiologic abnormalities may be associated with neurocognitive deficits, but their specific causes remain unclear.12,13

This article originally appeared on Cancer Therapy Advisor