Young women and Black women at higher risk of chemobrain, study finds

The largest study of chemobrain in women treated for breast cancer has shown that problems with thinking, concentrating and memory can continue 6 months or more after chemotherapy ends. Researchers reported their findings in the Journal of Clinical Oncology.

Background

Women treated for breast cancer often report trouble paying attention, organizing their thoughts and remembering words. Together, these treatment side effects are commonly called chemobrain, because people with all types of cancer often report them during and after treatment with chemotherapy. Other factors, including depression, anxiety, genetics or non-chemotherapy treatments may lead to these types of problems.

Researchers are still exploring what problems occur with chemobrain, who is affected by it and how it can be managed. For years, many women who reported these cognitive, or thinking, difficulties to their care teams had their concerns ignored or were told chemobrain was not real.

In the past, studies tried to measure these problems through tests of thinking, memory and motor skills. The studies also asked women who had been treated for breast cancer about their experiences. Unfortunately, some of these studies included only small groups of women or people with different types of disease, not just breast cancer. As a result, chemobrain related to breast cancer treatment is still not well-understood.

The researchers in this study wanted to look at a large, diverse group of women, with and without breast cancer, to measure the impact of breast cancer and chemotherapy on thinking. They also wanted to find out if age, race, anxiety, depression, type of breast cancer treatment or other characteristics were linked to cognitive problems.

Design

The study followed 581 women diagnosed with early-stage breast cancer. The women were treated with chemotherapy at 22 community oncology clinics nationwide and compared to a control group of 364 women who did not have breast cancer.

Women in the study ranged from age 22 to 81. Both study groups had a mean age of 53. About 7 percent of participants were Black.

The researchers gathered information about each woman’s age, race, education level and the type of breast cancer treatment she had. Before they started chemotherapy, the women took tests measuring anxiety and depression levels. Their reading ability was also tested, to show each woman’s cognitive reserve, a measurement that researchers use to see how well the brain can recover or adapt to changes caused by medicine or injury.

To measure chemobrain and its effect on quality of life, the researchers used the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) tool. This tool measures perceived thinking difficulties related to cancer treatment by asking the survey taker to rate how often they have an experience such as, “I have forgotten names of people soon after being introduced” or, “Other people have told me I seemed to have trouble remembering information.” The statements are rated on a scale from “Never” to “Several times a day.”

The FACT-Cog and other tests were given to all participants 7 days before their first chemotherapy treatment, within 4 weeks after chemotherapy was completed and then again 6 months later.

Results

A significant number of women treated with chemotherapy experienced chemobrain:

• From before chemotherapy started to after it ended, 45 percent of women receiving treatment reported a loss in thinking or memory compared with 10 percent of women in the control group.
• From before chemotherapy to 6-month follow-up, 37 percent of those who received chemotherapy reported having more trouble with thought and memory compared to 14 percent of controls.
• Those with anxiety, depression or lower cognitive reserve at the start of the study were more likely to report trouble with thinking or memory.
• Young women and Black women were especially likely to experience cognitive difficulties.

Chemotherapy type, hormonal therapy and radiation therapy were not significantly associated with chemobrain.

Limitations

In this study, chemobrain was only measured up to 6 months after chemotherapy treatment ended. The researchers are now looking at a small group of these women to see if they have difficulties 2 years after treatment.

What this means for you

Chemobrain is a real condition people have experienced for years that research is now catching up to. The study authors call it “a substantial and pervasive problem” for women with breast cancer who receive chemotherapy. If you are having trouble with memory or thinking, talk with your oncologist and healthcare team. Keep a record of when your symptoms happen and what they are. Bring that record with you to talk about what you’re experiencing.

You can find ways to manage factors that may make symptoms of chemobrain worse, like lack of sleep, anxiety and stress. Moderate exercise, yoga, meditation and eating healthful, nutritious foods may help with some of those factors.

You can manage some chemobrain effects by keeping track of tasks and dates on lists or calendars. To focus better, avoid multitasking and go to a quiet location to talk or work.

The “fog” of chemobrain starts to lift 6 to 12 months after treatment ends for many people. For others it may take longer. If you don’t get the help you need from your doctor, talk with an oncology counselor or a neuropsychologist.

Janelsins, MC, Heckler, CE, Peppone, LJ, et al. Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study. Journal of Clinical Oncology, 2016; DOI: 10.1200/JCO.2016.68.5826