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LETTER TO THE EDITOR
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 286-287  

Chemo brain – The need to defog the cognitive offshoot of chemotherapeutics


Department of Psychiatry, St. John's Medical College and Hospital, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India

Date of Web Publication15-May-2019

Correspondence Address:
Suhas Chandran
Department of Psychiatry, St. John's Medical College and Hospital, St. John's National Academy of Health Sciences, Sarjapur Road, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_131_18

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How to cite this article:
Chandran S, Perugu S. Chemo brain – The need to defog the cognitive offshoot of chemotherapeutics. Med J DY Patil Vidyapeeth 2019;12:286-7

How to cite this URL:
Chandran S, Perugu S. Chemo brain – The need to defog the cognitive offshoot of chemotherapeutics. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2019 May 25];12:286-7. Available from: http://www.mjdrdypv.org/text.asp?2019/12/3/286/258198



Dear Sir,

Modern-day cancer therapy has witnessed the expansion of existing chemotherapeutic regimens and the introduction of new agents which has resulted in a significantly reduced risk of recurrence and a higher survival rate in several types of cancer. However, one particular fallout of modern cancer therapy is the postchemotherapy-related cognitive dysfunction, referred to as “Chemo brain” or “Chemo fog.” While it is possible that the respective cancer itself can cause cognitive impairment on its own merit,[1] a defining hallmark of “Chemo brain” is the onset of the dysfunction after treatment initiation and the subsequent analogous assumption of causality. These symptoms may be short term in most patients, but the findings from the International Cognitive Workshop suggest that chemotherapy-related cognitive dysfunction may be long term in some and has been reported to last even 5–10 years after treatments in cancer survivors.[2]

These patients consistently report clinically significant cognitive dysfunction that hinders their daily function, notably with the domains of attention, concentration, forgetfulness, word finding, multitasking, and organization being most affected. The clinical presentation of Chemo brain is conspicuous for the discordance between the subjective experience of cognitive deficits and objective neuropsychiatric measures.[3] The standard instruments that we have been traditionally using for cognitive evaluation were not designed for the cognitive changes that cancer patients/survivors experience. They were more devised for head injuries, stroke, Parkinson's disease, or Alzheimer's disease.

Another crucial feature of Chemo brain is its common relationship to a cluster of somatoform symptoms, anxiety, depression, sleep disturbances, fatigue, and overall health-related decline.[4] The other medications taken by the patients for the common comorbidities associated with cancer can also deleteriously impact cognitive function. It is therefore imperative to first address these potential confounding issues in whom chemotherapy heralds cognitive concerns and studies looking at these connotations are currently sparse. Treatment for the symptoms of Chemo brain can include cognitive compensatory strategy training to minimize the detrimental impact of specific cognitions on important life tasks, training with the use of cognitive prostheses, psychotherapy to ease adjustment and adaptation, energy conservation to maximize cognitive efficiency, and work-related revisions. Similarly, aerobic exercise also has potential benefits on cognition, as exercise increases blood flow to the brain.[5] Nevertheless, there are too few studies with long-term follow-up data to have any certainty of any of these treatment strategies.

Going forward, biomarker-based risk prediction studies are also needed to help us identify the population at risk, on the grounds of which preventive strategies and risk-adapted treatment approaches can be drafted. Preclinical studies can help us isolate the mechanisms leading to cognitive dysfunction, and drugs could be developed to target those mechanisms, resulting in prevention or treatment strategies to enhance cognition. Treatment-related cognitive dysfunction in cancer patients directly impacts patients and their families and creates a ripple effect with important implications for our health-care system and the larger global economy. Considering the diversity of symptoms, the wonder drug that can cure all cancers and has no side effects might not be found. What we can do still is to reduce the impact and intensity of cognitive side effects by taking into account an individual's genetics and other determinants. This is an area of exceptional need and opportunity, one that should be actively encouraged at a multitude of centers nationally. These collaborative efforts will hopefully add more empirically supported solutions in our quest to “defog” this cognitive offshoot of chemotherapeutics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wefel JS, Saleeba AK, Buzdar AU, Meyers CA. Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer 2010;116:3348-56.  Back to cited text no. 1
    
2.
Vardy J, Wefel JS, Ahles T, Tannock IF, Schagen SB. Cancer and cancer-therapy related cognitive dysfunction: An international perspective from the Venice cognitive workshop. Ann Oncol 2008;19:623-9.  Back to cited text no. 2
    
3.
Hutchinson AD, Hosking JR, Kichenadasse G, Mattiske JK, Wilson C. Objective and subjective cognitive impairment following chemotherapy for cancer: A systematic review. Cancer Treat Rev 2012;38:926-34.  Back to cited text no. 3
    
4.
Ray M, Rogers LQ, Trammell RA, Toth LA. Fatigue and sleep during cancer and chemotherapy: Translational rodent models. Comp Med 2008;58:234-45.  Back to cited text no. 4
    
5.
Cormie P, Nowak AK, Chambers SK, Galvão DA, Newton RU. The potential role of exercise in neuro-oncology. Front Oncol 2015;5:85.  Back to cited text no. 5
    




 

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