According to neuropsychologists, treating chemo brain necessitates a multifaceted approach, and cognitive behavioral therapy may provide some relief. Shannon Colleary claims that she felt foggy after finishing her second round of breast cancer chemotherapy.

Colleary, 57, a screenwriter in Los Angeles who finished treatment in October 2021, claims, “I had no short-term memory at all.” I would wonder, “Why am I here?” Who is this person who greeted me just now? From where do I know her?’ Then I’d act like I knew them, but I often left the conversation still not knowing who they were.

Since completing treatment for Hodgkin’s lymphoma in April, Justin Schuster, 19, of Rye Brook, New York, has described his brain as “empty.” Schuster left Lehigh University in December after discovering a swollen lymph node just above his collar bone. “My thoughts aren’t processing,” he says. I can’t track down the word, and I fail to remember what I’m attempting to say.”

A debilitating medical condition characterized by loss of word retrieval, memory, and executive function, as well as an inability to concentrate, is commonly referred to as “chemo brain,” as both Colleary and Schuster describe it. Cancer-related cognitive impairment (CRCI) is the term used by doctors for it. According to research, it affects about 75% of cancer patients while they are receiving treatment, and 35% of those patients continue to experience symptoms even after the treatment has ended.

It’s still unclear why some people get the condition and others don’t, and why some people have symptoms that last for years while others get better in a few months.

However, NYU Langone’s Perlmutter Cancer Center’s director of the Supportive Oncology Program, Arum Kim, advises patients to discuss cognitive changes with their medical team.

She asserts, “Really good, calm communication with your treating oncology team is important because there are things we can do for it if we know about it.”

What brings about “chemo brain”?
Inflammation, according to Jeanne Mandelblatt, the inaugural director of the Georgetown Lombardi Institute for Cancer and Aging Research, is a factor.

“While chemotherapy kills cancer cells, it also damages cells that can speed up aging and raises inflammation, including brain inflammation. That may have an impact on cognition,” asserts Mandelblatt, who is in charge of the 15-year longitudinal Thinking and Living With Cancer study, which focuses on cognitive impairment in elderly breast cancer patients.

She adds, however, that the term “chemo brain” is a misnomer because patients also experience cognitive impairment from immunotherapy and hormone therapy. She says, “It’s not all one thing, but it is a real thing, and people have cognitive problems that make their lives hard to live.”

Chemo brain most likely begins as a direct result of the cancer itself.

“While recovering from cancer, individuals are dealing with a variety of other issues that may or may not have an effect on their brain but may or may not. Insomnia is extremely common in this population. There may be significant lifestyle shifts and high rates of anxiety and depression. Nicolette Gabel, division director of rehabilitation psychology and neuropsychology at the University of Michigan Rogel Cancer Center, adds, “And those can make you less effective than you were before.”

Colleary claims that her severe depression during treatment was even more severe than her loss of short-term memory.

According to what she claims, “It became very clear to me that the chemo drugs had killed every positive hormone in my brain.” Endorphins, oxytocin, dopamine, and serotonin simply did not exist. At times, I became nihilistic and asked, “What’s the point of life?” It’s too risky, lonely, and depressing.

Effective treatments, according to neuropsychologists like Gabel and Eric Zhou, an assistant professor at Harvard Medical School who specializes in disease recovery, require a multifaceted strategy to treat chemo brain.

According to Gabel, “it is a combination of cognitive retraining and mindfulness practices to help reduce stress [and] improve things like sleep and relaxation and take down that kind of high-level cortisol stress that goes on when people are going through these changes.” This kind of stress occurs when people are going through these changes.

Regarding cognitive symptoms, Zhou encourages patients to consult their physicians as soon as possible. According to a recent study, the following treatments improved patients’ symptoms:

Exercise: According to the study’s lead author and associate professor at the University of Rochester Medical Center, Michelle C. Janelsins-Benton, those with breast cancer who exercised for 150 minutes per week had similar cognitive function to those in the control group.

According to Janelsins-Benton, “individuals who were physically active at the time of their diagnosis had better cognitive maintenance, compared to those who were not physically active prior to treatment,” even if they did not maintain that level during treatment.

She thinks that exercise fights the body’s inflammation, which could be a factor. Janelsins-Benton found in another study that moderate exercise also helps patients maintain their attention span. Although more research is needed, I believe this is a very promising benefit of exercise,” she states.

According to Gabel, a form of cognitive behavioral therapy known as memory and attention adaptation training is particularly effective and is something that patients can easily perform at home.

Sleep: According to Zhou, not getting enough sleep “amplifies the physiological changes that are occurring for someone who has chemo brain.” Consult your doctor about trying cognitive behavioral therapy (CBT), which is regarded as the most effective treatment for insomnia, if you are having trouble falling asleep at night. Zhou suggests adjusting bedtimes, making your bedroom more restful, and using a technique called “sleep restriction,” in which you limit the amount of time you spend in bed to the hours you spend sleeping, not watching TV, reading, or playing on your smartphone.

Mindfulness: A brief study of breast cancer patients found that yoga, meditation, and deep breathing could help with cognitive issues. We don’t know why this helps, whether it’s because of a mind-body connection or because these things are good for us as a whole, according to Zhou.
Psychostimulants: Drugs like Adderall may help, despite the lack of clinical evidence for their effectiveness. These drugs can have a significant effect on people who struggle with attention and cognitive fatigue, according to Gabel.

According to Gabel, cancer patients shouldn’t avoid treatment because they fear cognitive impairment.

She asserts, “All of this can sound very frightening to people, and I worry that people will reject treatments that could be curative.” Twenty years ago, cancer survival rates would have been out of the question. The occurrence of chemo brain is not guaranteed, but if it does, there are strategies for dealing with it.

Although Mandelblatt predicts that physicians will soon be able to offer pharmaceutical solutions to their patients, there are currently no FDA-approved solutions for chemo brain.
Mandelblatt states, “We are making some progress, and I expect that already approved drugs will be repurposed for chemo brain,” pointing to promising studies in mice.

According to the study’s author, Daniela Salvemini, director of the Institute for Translational Neuroscience at St. Louis University School of Medicine, one of these studies demonstrated that Cisplatin, a commonly used chemotherapy drug, alters the sphingolipid metabolism in the hippocampus of a mouse brain—where memory is stored—and that this alteration plays a crucial role in chemo brain.

After giving Fingolimod and Zeposia to mice, Salvemini’s group found that these drugs, which are already approved by the FDA to treat multiple sclerosis, could prevent the development of chemo brains.

Salvemini states, “I think this could be a revolutionary approach to the treatment of cancer patients and cancer survivors,” despite the fact that human trials are required. This has us very excited. Chemo brain is a real thing. Even though not everyone is affected, those who are are profoundly affected in their lives.

Topics #brain empty #breast cancer chemotherapy #Chemo Brain #Hodgkin's lymphoma #neuropsychologist