Cognitive Impairment Previously Linked to Chemotherapy May Originate Before Treatment

The mental toll and stress of a breast cancer diagnosis might factor into the cognitive impairment experienced during chemotherapy treatment, commonly referred to as "chemo brain."

Bernadine Cimprich, PhD, RN

The mental toll and stress of a breast cancer diagnosis might factor into the cognitive impairment experienced during chemotherapy treatment, commonly referred to as “chemo brain.” At the 35th Annual San Antonio Breast Cancer Symposium, Bernadine Cimprich, PhD, RN, presented data suggesting that pretreatment neurocognitive compromise and fatigue contribute to cognitive issues formerly associated solely with chemotherapy.

“Our [previous] work and the work of others has shown that cognitive complaints and deficits have occurred even before chemotherapy, so these [problems] could not be attributed to the treatment,” said Cimprich, who is an associate professor emerita at the University of Michigan School of Nursing in Ann Arbor. “It’s important to find solutions because even subtle cognitive changes can have a considerable negative impact on a person’s functioning and their quality of life. And, further, concern over ‘chemo brain’ may result in patient reluctance to accept life-saving therapy.”

In their latest study, Cimprich and her colleagues analyzed neurocognitive responses in 66 women with localized breast cancer (stages 0-IIIa), as well as in 32 healthy controls. Patients were receiving either an anthracyline-based adjuvant chemotherapy combination (n = 29) or radiotherapy (n = 37).

Cimprich explained the design of the trial: “Functional magnetic resonance imaging was used to directly test brain function while a woman was performing a working memory task in the scanner before adjuvant treatment and then 1 month after adjuvant treatment.”

After each scan, patients self-reported on levels of cognitive functioning and fatigue.

In both patient groups, pretreatment brain imaging revealed lower functioning versus the control arm in frontal regions of the brain that were necessary to the performance of the working memory task. The cognitive impairment was most severe in women awaiting chemotherapy. “The chemotherapy group actually had the lowest level of activation [before treatment] and [results] with the radiation group fell between the prechemotherapy and the controls,” said Cimprich.

Additionally, lower functioning in this area of the brain before treatment predicted the severity of fatigue, and greater fatigue was linked with greater cognitive impairment over time.

Cimprich said the study demonstrates the need for increased awareness of the vulnerability of women awaiting chemotherapy to cognitive problems related to worry and fatigue. She added that earlier identification and intervention is needed for women at greater risk.

In her concluding remarks, Cimprich noted that the study findings suggest that “chemo brain” might be an inappropriate term to describe cognitive problems in patients with cancer.

Cimprich B, Hayes DF, Askren MK, et al. Neurocognitive impact in adjuvant chemotherapy for breast cancer linked to fatigue: a prospective functional MRI study. Presented at: 2012 CTRC-AACR San Antonio Breast Cancer Symposium; December 4-8, 2012; San Antonio, Texas. Abstract S6-3

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