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Chemobrain May Start Before Chemo

By December 19, 2012

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Chemobrain had me in its grip while I was in treatment for breast cancer, and its effects lingered. I was warned about it, but didn't really believe it would happen to me, until one day at work when I could not understand a Powerpoint presentation given by a coworker. The words were clear, well organized, and familiar. But I could not make sense of them. I knew that I felt foggy-headed, but perhaps that was due to fatigue? My oncologist confirmed that my symptoms matched those of chemobrain - after having 3 rounds of strong chemo drugs and 6 rounds of Taxol (given in smaller doses) I was feeling brain-fried. Dr. Bernadine Cimprich has studied the before and after symptoms of women taking chemo for breast cancer, and found that the cognitive fogginess can set in even before the first infusion of chemo has been given.

Dr. Cimprich presented the results of her study at the 2012 San Antonio Breast Cancer Symposium. Her study compared two groups of women - one group was healthy and close in age to the second group, all of which had been diagnosed and operated on for breast cancer, but had not yet taken chemo or radiation. Women in both groups answered a survey about their levels of fatigue. All the study participants took the Verbal Working Memory Task test while having functional magnetic resonance brain imaging. The memory test has several levels of difficulty through which the subject must pass. After that first test, the women also took Attentional Function Index and the Functional Assessment of Cancer Therapy-Fatigue tests. Once treatment started for the actual patients, those taking chemo said they had greater levels of fatigue than those having radiation.

Chemo patients were found to have memory difficulties and greater fatigue than radiation patients, and both groups were more fatigued that the healthy subjects. No surprises there, but once treatments started and these test were repeated, chemo patients took the prize for worst cognitive problems as well as worst fatigue.

The surprising thing that Dr. Cimprich found was this: women who were post-surgical and pre-chemo already had some cognitive problems as well as greater fatigue levels.  Their memory problems can show up about a month before chemo starts, as well as those feelings of being wiped out - and this is even before experience the side effects of chemotherapy. So what may be causing this precursor of chemobrain symptoms? Dr. Kent Osborne of Baylor College of Medicine in Houston remarked that he, "often wondered if [chemo brain is] "as much related to the worry, anxiety, and stress at to the treatment itself." That rings true, I think - after a woman has faced the possibility of losing a breast, gone through the surgery, faced her mortality, and been told that she will have to take chemotherapy, she would be perfectly within her rights to feel fuzzy-headed (from shock) and fatigued (from the strain) as well as overwhelmed (by all the medical information).

I'm glad there is medically-backed proof that breast cancer patients have these cognitive challenges as well as the whole package of emotions and physical changes. Don't let anybody tell you that chemobrain is "all in your head." Yes, the symptoms may appear there, and you may well have the energy of an old washrag, but it is not as simple as just having chemo side effects. Facing a breast cancer diagnosis and accepting the prospect of chemo and all the well-publicized sickness, hair loss, and debilitation that goes with it is enough to bring on anticipatory brain fog. But now, the doctors know that too, and perhaps we can be treated more humanely because of that.

Source:
Cimprich B, at al "Neurocognitive impact in adjuvant chemotherapy for breast cancer linked to fatigue: a prospective functional MRI study" SABCS 2012; Abstract S6-3.

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