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Chemo Brain: It’s Not All in Your Head

Heather Millar - Blogs
By Heather MillarAward-winning writerFebruary 12, 2015
From the WebMD Archives

Four years ago, when I was just out of active treatment, I went to a seminar about breast cancer. While there, I asked a question about “chemo brain,” that mental fogginess that plagues a subset of cancer patients during treatment, and sometimes for years afterward.

The doctor who chose to answer my question reminded me that chemo brain had yet to be really described as a physiological thing. The doctor suggested that it may be a result of stress or depression.

I remember being annoyed at the time. Really annoyed.

You see, I had chemo brain. I could not keep my thoughts straight. I could not concentrate. I had trouble reading, following the argument of a story. These are big problems for a writer. Yes, I was under stress. Yes, I got as depressed as any other cancer patient. But my mental problems were more than that.

Luckily, my symptoms faded with time. That’s not true for all survivors. I would have been really frustrated if I’d had to keep trying to convince doctors that my cognitive problems were real. My heart goes out to long-term survivors who continue to struggle with mental difficulties. I’m sure that has deep emotional and economic costs.

Finally, in the years since I asked my chemo brain question, new imaging techniques have helped researchers begin to build evidence that chemo brain IS a physiological thing. Doctors from Harvard and the Netherlands published a really excellent 2013 review of the progress here.

Different research teams have tested a wide variety of chemo agents: cisplatin, doxyrubicin, methotrexate, vincristine and many others. They’ve found that chemo drugs seem to make the brain shrink slightly, reducing both white matter and gray matter.

Some chemo agents interfere with how brain cells, neurons, divide to form new cells. Others mess up the signaling between neurons, or how the cells process oxygen.

Scientist also have found that patients who are treated with multiple chemo drugs for longer periods have a greater risk of developing chemo brain. That seems obvious to me, but I know scientists are supposed to prove things, not just go on gut feelings.

This is all good news. In fact, enough evidence for the existence of chemo brain has emerged that the National Comprehensive Cancer Network included the condition in its 2014 Survivorship Guidelines.

Alas, while doctors may now mostly accept that chemo brain is a real thing, they don’t have many treatments for it. Some studies have tried treating chemo brain with stimulants and erythropoietin, but have achieved mixed results. Other groups have has some success using cognitive behavioral therapy, exercise, and cognitive training to treat patients and survivors suffering from chemo brain. Antidepressants and anti-oxidants have also been tried.

There’s a still a long way to go. But if you’re feeling fuzzy-headed during or after treatment, take comfort in the fact that it’s not your imagination. Remember that even if these symptoms persist, they don’t seem to be progressive, as is dementia.

Do you suffer from chemo brain? Has anything helped you with the symptoms? What did your doctor say? Let us know here.

Editor’s note: All comments go into a moderation queue (so will not immediately appear).

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About the Author
Heather Millar

Heather Millar is an award-winning freelance magazine writer and author with wide-ranging interests including health, science, the environment, geopolitics, technology, parenting, and Asian affairs. 

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