You don’t have to spend very long with a group of breast cancer survivors before you hear one of them mention chemobrain even if it is just a throw-away line used to excuse a memory lapse. While these symptoms, such as easily becoming distracted or having difficulty remembering names and words, are all-too-familiar to many survivors, they often have been dismissed by medical professionals. But now, thanks to researchers who took these concerns seriously, we’ve got two recently published papers that clearly substantiate survivors experiences.
The first study, which was published in the Archives of Neurology in November 2011 was conducted at Stanford University and used the Love/Avon Army of Women to recruit! The Stanford research team used functional MRI imaging to compare the brain images of healthy women and women with breast cancer. The study was not large; it included 25 survivors who had received chemotherapy, 19 survivors who had only had surgery, and 18 healthy controls who were matched for age, educational level, and menopausal status. It focused on executive functions (cognitive processes, such as planning mental flexibility, and working memory) and the women were all tested on verbal fluency, problem solving, and attention. In addition, each study volunteer was asked to assess her own cognitive abilities. The study found that not only did brain activity differ between healthy controls and cancer survivors, but that those survivors who had undergone chemotherapy had additional specific differences and decreases in executive function.
The second study, which was published online in December in the Journal of Clinical Oncology, was conducted in the Netherlands. This research team’s well-designed study enrolled premenopausal women with breast cancer and compared their cognitive complaints, brain function, and MRIs before initiating and after completing chemotherapy. The researchers also compared these women to similar women with breast cancer who did not have chemotherapy, and healthy women not being treated for cancer. As would be expected, the breast cancer patients reported more depressive symptoms at baseline (after diagnosis and before treatment) but otherwise the three groups were the same.
When the researchers repeated the tests three-to-four months later the two control groups (the breast cancer patients who had not had chemotherapy and the healthy women) actually did better on attention and concentration as well as memory and processing speed, most likely because they were familiar with the testing the second time. However, the women who had been treated with chemotherapy had declines in all areas, which matched their self-reported experiences and their brain imaging.
This information is exciting because we now have solid data to support what women have been saying about chemobrain it’s real! Now the hard work begins: sorting out whether it is true for everyone; whether we can we predict who and what drugs specifically cause it; and learning if it gets better over time or whether women just learn to adapt.
Obviously some women need chemotherapy to save their lives, but often it is given just in case. Studies like these need to be balanced with a realistic assessment of chemotherapy’s value in each specific woman. And as my colleague, Dr. Patricia Ganz wrote in her editorial on the subject: We can no longer deny the existence of this long-term effect of cancer treatment; we must work to tailor future treatments to minimize this adverse outcome.