Chemo Brain Seems to Start Before Chemotherapy Treatment, May Be Linked to Stress and Fatigue

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Many women who get chemotherapy to treat breast cancer say they have problems remembering, thinking, and concentrating during and after treatment. These problems are commonly called “chemo brain” or “chemo fog” – doctors call these issues “cognitive impairment” or “cognitive problems.”

Some women may have trouble with:

  • learning new tasks
  • remembering names
  • paying attention and concentrating
  • finding the right words
  • multitasking
  • organizing thoughts
  • remembering where things are (keys, glasses, etc.)

A small study has found that about a month before chemotherapy was supposed to start, many women were already having memory problems and that these problems may be more closely linked to the stress and fatigue that come with a breast cancer diagnosis than to chemotherapy.

The study was presented at the 2012 San Antonio Breast Cancer Symposium.

To see if women diagnosed with breast cancer had changes in their brains, the researchers used functional MRI scans to measure brain activity. Functional MRI does this by detecting changes in blood flow in various parts of the brain.

The researchers looked at the brain function of 65 women diagnosed with early-stage breast cancer (stages 0-IIIA) and compared them to 32 women who hadn’t been diagnosed with breast cancer who were about the same age. Among the women diagnosed with breast cancer:

  • 28 were going to have chemotherapy after surgery
  • 37 were going to have radiation after surgery

The researchers did the functional MRI scans of the women diagnosed with breast cancer at three points during treatment:

  • after surgery
  • a month before starting chemotherapy or radiation
  • either a month after chemotherapy ended or 5 months after radiation ended (this time difference meant the women had the third functional MRI scan at about the same time)

The women who hadn’t been diagnosed with breast cancer had two functional MRI scans:

  • one after a negative mammogram
  • one 5 months later

The women did a verbal working memory task while getting the functional MRIs.

Each time they had a functional MRI, the women told the researchers how they felt they were thinking and remembering, as well as the level of fatigue they were experiencing.

Compared to the women who were scheduled to get radiation and the women who hadn’t been diagnosed with breast cancer, the women scheduled to get chemotherapy:

  • experienced more severe fatigue; this difference was significant, which means that it was likely because of the scheduled chemotherapy and not just due to chance
  • did worse on the memory task during the functional MRI after surgery
  • had less activation in the left inferior front gyrus, a part of the brain that is very important in working memory tasks

The women scheduled to get radiation did better on the memory tests than the women scheduled to get chemotherapy, and the women who hadn’t been diagnosed did the best on the memory tests.

In all three groups, women who reported more severe fatigue did worse on the memory tests and reported more thinking and memory problems.

The good news is that most of the women who were scheduled to get chemotherapy recovered much of their thinking and memory abilities after chemotherapy ended – there weren’t many differences in the final functional MRI scans between the three groups.

This study suggests that “chemo brain” may not be the best name for the thinking and memory problems that may happen after a breast cancer diagnosis. More research is needed, but it seems that the problems are caused – at least in part – by the stress and fatigue that comes with a breast cancer diagnosis.

Instead of focusing on treatments to improve memory, treatments to ease fatigue may be more helpful for women who have thinking and memory problems. Some complementary and holistic medicine techniques have been shown to reduce fatigue, including:

  • acupuncture
  • massage
  • meditation
  • Reiki
  • tai chi
  • yoga

Small studies and anecdotal evidence suggest that lifestyle changes such as exercising more, relieving stress, getting enough sleep, and eating a balanced, healthy diet can help ease fatigue.

If you’ve been diagnosed with breast cancer and are having thinking and memory problems and are experiencing fatigue, there are things you can do to help yourself. Visit the Breastcancer.org page on Fatigue to learn more about how to manage this very common side effect.

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