Chemo Brain for the Multiple Myeloma Patient

An interesting article, titled “Chemo Brain’ : an imprecise term for a complex phenomenon” was just published on-line. The article gets right to the point from the start :

‘The various cognitive impairments collectively known as “chemo brain” can cause anxiety, frustration and difficulty with everyday tasks for cancer survivors. Despite what the term suggests, “chemo brain” and its associated mental changes are not necessarily related only to chemotherapy. Other cancer treatments also can have short- or long-term cognitive implications. Additionally, some changes in cognitive function may be associated with the cancer itself.’

Most of us multiple myeloma patients, will be familiar with ‘anxiety, frustration, difficulty with everyday tasks’ especially during the early months of our treatment and in the periods post-stem cell transplant. It takes awhile to get us back to the point where we can more than one thing at a time. The whole article is about 7 pages long but quite easy to read and I highly recommend you read it. I am just going to lift some snippets here that are more specific to us, myeloma/blood cancer patients.

One of the authors states : “One of the pieces of this puzzle [seeking to identify the mechanisms behind cancer-related cognitive decline, as well as ways to manage them] is that some people appear to be more affected than others. So, part of the challenge is in identifying the underlying mechanisms and subgroups of patients who are impacted.”

Other physicians added : 

• Most of the time, the foggy sensation related to having cancer will resolve over 6 to 12 months after the cancer is successfully treated. However, a portion of survivors, ranging from 20% to 70% depending on the type of treatment, exhibit permanent cognitive deficits.”
• Because cognitive impairment among cancer survivors has also been noted in patients treated with hormone therapy, radiation, bone marrow transplantation and surgery, the term “chemo brain” is misleading.”
• Studies show that up to a third of people have cognitive symptoms before they get any cancer treatment, so there’s belief that maybe the inflammatory response to the cancer might be contributing to the cognitive symptoms. These inflammatory cytokines may be produced in response to the cancer, the chemotherapy, or even psychological symptoms such as depression and anxiety. These may all be synergizing.” [emphasis added]

And it is not just chemotherapy that contributes to “chemo brain”.

• “General anesthesia (with surgery) has been associated with cognitive effects lasting between 4 and 6 weeks.”
• More specific to myeloma patients are these observations : “Cognitive impairments can occur after patients with hematologic cancers undergo hematopoietic stem cell transplantation.” “We found that allo-transplants recipients, treated with full-intensity conditioning were the most compromised group when compared with healthy controls. Non-myeloablative HSCT recipients showed evidence of delayed decline, [whereas] patients receiving an autologous HSCT were generally spared.”

When it comes to older patients, “it may be difficult for clinicians to differentiate cognitive decline linked to cancer from early dementia or age-related memory loss. Additionally, these patients may be taking medications for comorbid conditions that may compromise their cognitive function. In these cases, a comprehensive geriatric assessment would be required, ideally by a geriatric oncologist.”

Also, worth noting is this comment : “It is important to rule out other possible explanations for cognitive issues. He said conditions such as hypothyroidism, anemia, electrolyte imbalance, sleep apnea, depression or B12 deficiency may account for cognitive issues.”

When it comes to treating “chemo brain” you may wish to be aware of the following observations made by several of the authors quoted in the article :

• “There are many different factors that may contribute to cognitive changes in the cancer setting, and so I don’t think there is going to be a singular mechanism for everyone. There is a need to look at this broadly, to see what factors are playing a role for each person, and to target interventions to that person.”
• “Learning systems of adaptation and behavior modification may be an effective way for some patients to overcome cancer-related cognitive decline.”
• “Drugs being investigated include psychostimulants, which have yielded mixed results at best.”
• “Reasonable lifestyle changes, which most patients can safely make, are another way to potentially combat cancer-related cognitive decline. …  factors such as obesity, insomnia and even loneliness have been found to be associated with cognitive impairment among patients who have survived cancer.
• "Exercise is a powerful lifestyle component that may have an impact on several mechanisms of cancer-related cognitive impairment. There is emerging evidence that aerobic exercise supports cognitive recovery.” [emphasis added]