'Chemobrain' just starting to get serious attention from researchers

MILWAUKEE - LeAnn Sucher was at her son's tennis match shortly after she completed chemotherapy for breast cancer.

A former competitive tennis player herself, Sucher, 47, was having such a hard time remembering the score that she needed to use pebbles and stones to keep track.

Debbie Hintz, 45, came out of a Catholic bookshop while undergoing chemotherapy for breast cancer and couldn't find her car keys.

She went back into the store, where some older women told her to pray to St. Anthony, the patron saint of lost things. Eventually she found the keys, but she's still waiting for her old memory to show up.

After undergoing surgery, radiation and chemotherapy for his brain tumor, Jim Smyth, 45, developed extreme fatigue and concentration problems that didn't go away when the treatments ended.

He lost several jobs, including a six-figure sales position, and now delivers newspapers for a living.

For years, the condition that has come to be known as "chemobrain" was mostly an anecdotal phenomenon, talked about in cancer support groups, but not taken too seriously by the medical field.

But doctors are finding it harder to be in denial about the malady.

Over the last few years, research including brain imaging, cognitive testing and lab studies suggests that chemotherapy can have harmful effects on the brain.

A 2005 review article said that up to 40 percent of breast cancer patients who underwent chemotherapy suffered mild cognitive impairment, with memory loss and lack of concentration the most common symptoms. While the symptoms seem to be temporary, they can last for several years.

New drugs

As new cancer drugs are developed and cancer patients survive longer, the issue is getting more attention. Some physicians even are prescribing drugs normally used to treat ailments such as narcolepsy and attention deficit hyperactivity disorder for suspected chemobrain.

While chemobrain, also known as "chemofog," has gained more acceptance, there still is uncertainty over what causes it and whether it is temporary or permanent.

In two small groups of testicular and breast cancer patients, between 60 percent and 70 percent of the patients experienced some cognitive decline that was tied to the onset of their chemotherapy, said Christina Meyers, a professor and chief of neuropsychology at the M.D. Anderson Cancer Center in Houston.

"It's subtle," she said. "We are not talking about dementia or anything grossly obvious."

Within one year, about half of the patients were back to their pretreatment levels of cognitive ability, Meyers said.

For years, chemobrain was written off as a condition that came with the stress and depression of being diagnosed with cancer.

It also was attributed to the age of the patient, partly because many of those who complained of it were breast cancer patients who were in menopause. Indeed, chemotherapy can put a woman into early menopause, and some research suggests that up to one-third of breast cancer patient have some mild cognitive impairment before beginning treatment.

Kills brain cellsBut more recently, researchers have learned that chemotherapy agents can be lethal to brain cells.

When researchers at the University of Rochester last year tested three common chemotherapy drugs in the lab and on mice, they found that all three were toxic to brain cells.

In fact, the drugs were found to be more toxic to certain brain cells than to cancer cells, killing 40 percent to 80 percent of cancer cells and 70 percent to 100 percent of brain cells.

"We know they (the cancer drugs) get into the brain," said senior author Mark Noble, a professor of genetics, neurobiology and anatomy. "This is a problem to be taken seriously."

In addition to its direct neurotoxic effects, chemotherapy can affect hormone levels, which, in turn, can affect cognition. Another explanation is that chemotherapy can affect the immune system and lead to inflammation that can harm the brain.

In January, Japanese researchers using MRI scans found that breast cancer patients undergoing chemotherapy had shrinkage in certain brain regions, when compared with breast cancer patients who did not get chemotherapy.

The shrinkage corresponded to lower scores on tests of attention, concentration and visual memory one year after treatment.

The good news is that three years after treatment no differences could be found.

What to doThe big question that still remains: If doctors find a cognitive deficit, is there anything they can do about it?

Jim Smyth learned that he had a brain tumor in 2001 purely by accident.

He was selling medical equipment for a company that makes MRI scanners and volunteered to undergo a brain scan as part of a demonstration for a customer.

He became suspicious when the technicians who did the scan wouldn't tell him anything.

"Nobody would even look at me," Smyth said.

The next day he learned there was a tumor on the right side of his brain.

The tumor was surgically removed and found to be benign, but three years later the tumor was back, and this time it was cancerous, he said.

He went through surgery again and also underwent 45 days of radiation and a yearlong round of oral chemotherapy.

About halfway through the chemo, he started having memory, concentration and motivation problems.

He eventually lost three jobs.

Even more disappointing were the problems he was having playing games or just spending time with his children, who are 17 and 12.

"I'd say, 'No, I'm too tired,'" he said.

About a month ago, after an assessment at Froedtert's Neuro-Oncology Cognitive Clinic, Smyth was put on the drug Provigil (modafinil), a stimulant that can improve alertness and concentration.

The drug, which has been nicknamed the "genius pill," normally is used in people with sleep problems, but now is being tried in people with symptoms of chemobrain.

In Smyth's case it is not known whether the surgery, radiation, chemotherapy or all three have caused his cognitive problems.

In June, a University of Rochester study involving 68 women who had completed chemotherapy for breast cancer showed that Provigil substantially improved memory, concentration and learning.

Already, Smyth credits the drug with completely turning around his life.

His memory, concentration and motivation have improved, he said.

He recently got a job delivering newspapers every day.

"It's not near the money I was making," he said. "I was in the six figures. Now I'm making $250 a week. But it's more than the money. It's being part of the family and contributing to the family."