Treatment Online

Claims of "Chemo Brain" Investigated
> 4/18/2008 1:57:33 PM

A diagnosis of cancer comes with a horde of worries. Not only must patients face the possibility of death, but they must choose a treatment method and face the side-effects of the chosen treatment. Chemotherapy, which kills many healthy cells along with cancerous ones, has been suspected of damaging the mind as well as the body. So many patients report problems with thought and memory that the cognitive side-effect has a name: chemo brain. But naming something does not make it a reality, and two studies presented this week at the annual meeting of the American Academy of Neurology pokes some holes in the phenomenon.

Previous studies seemed to confirm that chemotherapy caused cognitive decline. However, two newer studies, done by Dr. Michael J. Boivin� and Dr. David G. Darby, combine to show that declines are really due to suffering and anxiety rather than harsh chemicals.

Dr. David G. Darby administered cognitive tests to 30 women before and after cycles of chemotherapy. Three women did show a small decrease in processing speed, but these declines were actually less significant impairments than could be found by comparing pre-treatment women to the general population. Obviously then, there has to be something besides chemotherapy that interferes with the thinking of cancer patients. This does not preclude the possibility that chemotherapy is one of the things that causes temporary mental impairment, but you should listen to anecdotal evidence with skepticism because there was no correlation between between self-reported perceptions of impairment and actual impairment. None of the three women who did objectively worse on the tests felt that they were thinking worse than normal.

Dr. Boivin offers a possible explanation for this early impairment in his study. He gathered three groups of women, those recently diagnosed with breast cancer but not yet started on chemotherapy, those whose biopsies recently turned out benign, and those who had survived treatment and had been in remission for a year. Subjects from each group took the CogState Neurolopsychological Assessment Battery as well as a variety of mood-assessment tests such as the HOPE Breast Cancer Quality-of-Life Scale.

Contrary to his expectations, pre-treatment women scored significantly worse on cognitive tests than post-treatment women. This poor performance was strongly correlated with levels of life hardship and anxiety. This indicates that it is not the treatment, but rather the stress of a diagnosis that clouds the mind. This is an important finding to disseminate to patients, because misconceptions about the risks of chemotherapy can add to stress, which is the real problem. Professional counseling and social support are an important part of handling any major physical illness, and could help to mitigate the cognitive burdens that seem to cause declines.

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