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Mental Difficulties Can Persist Long After Chemo Faith Reidenbach Journal of Clinical Oncology 2002;20:485-493. Years after receiving chemotherapy, survivors of breast cancer and lymphoma score worse on some tests of mental ability than those who had only surgery or radiation therapy, researchers say. Previous studies have documented that problems with memory, concentration, attention and learning, collectively known as cognitive dysfunction, occur in some cancer patients shortly after chemotherapy and are still present approximately 2 years later. The new research suggests that these problems--although relatively subtle--might last indefinitely, Dr. Tim A. Ahles and his colleagues report in a recent issue of the Journal of Clinical Oncology. At the time of their study, it had been approximately 10 years, on average, since the cancer patients had received chemotherapy. "The major message is that survivors' reports of cognitive problems should be taken seriously," according to Ahles. The investigators gave standardized tests of cognitive function to two groups of cancer survivors: 71 who had received chemotherapy and 57 who had undergone surgery and/or radiation therapy. All had been treated at least 5 years previously. In each group, about half of the patients had been treated for breast cancer and the others had been treated for lymphoma, which is a type of cancer that arises in the lymph nodes or similar tissue. Most patients, 85%, had needed only one course of standard-dose chemotherapy. The research team, which is based at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, found that more than twice as many survivors in the chemotherapy group did poorly on the cognitive tests compared with survivors who were given other types of treatment. That held true even after the researchers defined "low performance" in several different ways. An analysis showed that 24% to 50% of those treated with chemotherapy were in the low performance range, compared with 5% to 23% of those who did not get chemotherapy. Even though there was a difference between the treatment groups, "performance was generally within the normal range," the scientists report in their journal article. So the effects of chemotherapy can be subtle, but even so, "they can be very significant to the individual and can have a negative impact on work and school performance," Ahles told Reuters Health. Doctors don't yet know how chemotherapy affects the brain, whether only some chemotherapy drugs are toxic to the brain, or which subgroups of patients are at risk of long-term cognitive dysfunction. But even so, the research team emphasizes, "the survival benefits of chemotherapy far outweigh the potential risks to cognitive functioning for most patients." Also, "just because someone has received chemotherapy, it does not mean that the chemotherapy caused the cognitive problem," Ahles pointed out. "Problems with memory and concentration can be caused by medications, other medical problems, sleep disorders and psychological problems, for example depression and anxiety. Therefore, other potential causes of the cognitive problems need to be evaluated. This is particularly important since many of these other causes are treatable." Ahles added that "separating out the long-term effects of chemotherapy from the effects of normal aging can be difficult. However, survivors who report cognitive problems typically say that the problem started when they received chemotherapy and never got better."
Chemobrain V. Gammill Associated Press October 4, 2002 Ordinary doses of chemotherapy sometimes appear to permanently dull survivors' intellectual powers, leaving them with poor memories, muddy thinking and inability to do math in their heads, new research suggests. Cancer patients often complain of chemobrain, or woolly-headedness during treatment. While they are typically reassured this will go away, little attempt has been made until now to see if these subtle problems linger years later. The new study, conducted at Dartmouth Medical School, found that people who get standard chemotherapy appear to be about twice as likely as other cancer patients to score poorly on various intelligence tests an average of 10 years after their treatment. Doctors say the findings suggest that aggressive treatment with chemotherapy may be unwise in some people with early-stage cancer unless the drugs can substantially improve chances of survival. Tim A. Ahles, a psychologist, presented the results Tuesday at a meeting in Tampa of the American Cancer Society. He said that while his is one of the first formal studies of the problem, the results are unlikely to surprise many cancer patients. Ahles said that when he spoke recently about the findings at a meeting of cancer survivors, he worried his discouraging news would upset the audience. Instead, they seemed relieved that scientists were finally taking seriously a complaint they had made for years. He said that many years after treatment, some cancer survivors say they still have trouble remembering and concentrating. Some say they need a calculator for math problems they once could have solved in their heads. Others have to read a page twice to absorb what's being said. "In talking to someone, you'd never notice this,'' Ahles said. "But it is very relevant to them.'' Ahles noted that lots of things during chemotherapy can make people feel unfocused. Often they are anemic, sick from the chemotherapy and sleepy from anti-nausea medicines. But intellectual ability gradually comes back as they recover. "The question is whether it returns to pretreatment levels,'' he said. "The inference from our data is that for a subgroup of patients, it does not.'' In his study, Ahles tested 71 patients who were cancer-free after getting chemotherapy an average of 10 years earlier for breast cancer or lymphoma. They were compared with 58 who had been treated with radiation or surgery alone. Overall, the chemotherapy patients scored significantly worse, though most were still thinking clearly. However, between one-quarter and one-third of those who got chemotherapy scored near the bottom in at least four of the nine areas of intellectual ability that the researchers measured. Only half as many of the patients who got surgery or radiation alone did this badly. Dr. William Wood of Emory University in Atlanta noted that patients with early-stage cancer often opt for aggressive chemotherapy, even though statistically it offers only a percentage point or two improvement in survival. "This may give second thoughts to people who really would not get much benefit'' from chemotherapy, Wood said. Earlier studies have found a chance of lingering intellectual problems in people who receive high-dose chemotherapy, such as those undergoing bone marrow transplants. Doctors treating children with leukemia have also successfully turned to less toxic doses after finding the drugs cause learning problems.
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