Michelle Dawkins, age 56, takes her time finding the answers to questions and often seems to be thinking things over for a while before she replies. In fact, there is a medical reason for her reticence. First diagnosed in 2000 with breast cancer, Dawkins has been treated for cancer four times since then, including surgery, radiation, and multiple rounds of various chemotherapy drugs.
As might be expected, the cancer recurrences and repeated treatments have changed her life. For Dawkins, however, it is the ongoing memory problems that have become a day-to-day burden.
“I used to be able to easily remember names along with faces,” she said, “then I stopped being able to do even that. I started writing things down or trying to remember in a different way.” But the glitches have not gotten any better over time.
People who have been treated for cancer have known about this problem for years, even if they didn’t talk about it much or ask their doctors for help. Recently, the cluster of symptoms known most commonly as “chemo brain” has garnered medical attention and initiated a wave of discussion. Important work is now being done to understand the condition and, more crucially, to help alleviate it.
The mystery of chemo brain
The condition commonly involves cognitive changes including reductions in short-term memory and information-processing speed, and limitations or changes in an individual’s ability to organize information. The changes can be subtle and may be noticed only by the person experiencing them.
Signs of chemo brain can include:
Acknowledging the reality of chemo brain is a huge and needed start, but there is a long road ahead, according to Dr. Monique Cherrier, research associate professor of psychology at the University of Washington and affiliate investigator with Fred Hutchinson Cancer Research Center. Right now, it’s an unfortunate truth that curing cancer involves exposing people to chemotherapeutic agents, often to the point of toxicity.
“For a long time, we thought that these drugs did not cross the blood-brain barrier,” she said, “but there are studies now using animal models that show chemotherapy can cause cognitive deficits.”
It’s not entirely clear what mechanism leads to the reported and measureable mental shortcomings associated with cancer and cancer treatment. “I don’t like the term ‘chemo brain,’” said Cherrier. “There are so many factors that can reduce one’s optimal cognitive functioning” -- especially during cancer treatment, it seems. Immune system changes, hormonal fluctuations, the specific side effects of various drugs, crushing overall fatigue, chronic stress, psychological issues, and even the underlying effects of age all play a part in the spectrum of cognitive dysfunction that can manifest around cancer care.
Openly accepting that cognitive functioning can be impaired means that more work can be done to understand and, ultimately, alleviate the constellation of symptoms that affect patients. Cherrier is currently conducting a study focusing on cognitive rehabilitation exercises most commonly used for people with head injuries.
"There is strong literature showing that cognitive training helps the head injured population regain functioning and get back to work,” she said. “So we put together a seven-week training program for people with cancer.”
The program is group based; seven to 10 people meet weekly and not only learn new skills, but also get to practice them on each other. “We have taken the best of what is out there in cognitive rehabilitation exercises,” said Cherrier, “and then we tailor the program by asking participants to list their top concerns.”
The program also delivers education about how cognition works. “I am training participants to be their own scientists,” Cherrier said. “When you cannot think of a word or forget something, I tell them, let’s examine what factors could have contributed to that incident.”
Stress reduction is also a featured tool in the study. Fred Hutchinson Cancer Research Center behavioral psychologist Dr. Bonnie McGregor has combined forces with Cherrier to bring mindfulness meditation techniques to study participants.
“This is the first time looking at the effects of stress management in people with cancer,” said McGregor. Stress is associated with increased production of proteins called inflammatory cytokines, which research has linked to cognitive impairment. “It makes sense that reducing stress would help, and we are very optimistic.”
What you can do
Participants complete a battery of questionnaires before their first session and again at the end of the seven weeks. The preliminary data look promising, said Cherrier. When results are finalized, the researchers hope that the program will be offered to more patients in additional settings. Until then, if you are affected by chemo brain, there are some steps you can take.
Joely Johnson Mork is a freelance health and science writer/editor whose work has appeared in numerous consumer health books, as well as in Prevention and TIME. Her personal essays have been heard on NPR. Mork has a master’s degree in community health education and is a certified yoga instructor, whose students range from young children to adults. She also teaches yoga to people with cancer. Mork lives with her husband and 3 1/2-year-old son in Seattle.
Solid tumors, such as those of the breast, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.