Transcription:
Cancer Treatments and Chemo Brain

Host: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach so you have everything you need to live your life to the fullest.

Today, we're talking about chemo brain, who is at risk and how we can manage it with two of our experts, Dr. Haroon Ahmad, an Assistant Professor of Neurology at the University of Maryland School of Medicine and a physician specializing in neuro-oncology and neurology at the UM Marlene and Stewart Greenebaum Comprehensive Cancer Center. Also joining us is Katie Arensmeyer,, a senior nurse practitioner at the UM Marlene and Stewart Greenebaum Comprehensive Cancer center.

So Dr. Ahmad, to start us off, just what does chemo brain mean?

Dr. Haroon Ahmad: Chemo brain is a sort of a loosely defined term and really just refers to any patient that has gone through cancer treatment and develops symptoms down the road, which are often described as brain fog. You know, concentration issues, delayed, you know, short-term memory issues down the road. So it's loosely defined, but it is a true pathophysiologic phenomenon, meaning that we do know now these days that if you look at the MRI or functional MRI of a patient who is complaining of chemo brain, there is true findings of cognitive loss and neuronal loss down the road.

Host: And Katie, what types of treatments may put someone at risk for this chemo brain?

Katie Arensmeyer: So there are a lot of chemotherapies that can do that. Medications such as opioids or steroids, hormone treatments for breast cancer or prostate cancer. Chemotherapies, the only real studies that we have done that we know can affect it is something like the taxanes, paclitaxel or Taxotere. But there are other treatments such as radiation that can also cause chemo brain.

Host: And Dr. Ahmad, you mentioned that this is kind of a loose definition for chemo brain, but can you tell us a bit more about when during treatment this might happen to a patient and how long it could last?

Dr. Haroon Ahmad: Yeah, this can be as early as during treatment with, you know, many of the different types of treatments that Katie mentioned or it can happen months or years down the road. We sort of jokingly say that it's not a very funny joke, but we sort of say that chemo brain is a gift that keeps on giving, meaning that patients can often finish cancer therapy, be feeling well, and then a year or two down the road, just notice that they are, you know, requiring more post-it notes or, you know, having trouble keeping up at school or, you know, it can be as insidious as that.

But it sort of depends on the type of treatment. You know, again, whether it's radiation or hard cytotoxic chemotherapies or hormonal agents. They all sort of have their different profiles. But I guess the takeaway point on this one is it can be really months to years down the road. It doesn't necessarily need to be immediately afterwards.

Host: Gotcha. Okay. And if a patient is starting to notice this brain fog, memory issues, like you mentioned, Katie, what treatments are available to combat chemo brain?

Katie Arensmeyer: So right now, the best treatment are behavioral interventions. So things like cognitive training, doing puzzles, interacting with people. We always tell our patients that when they're receiving treatment for cancer, the worst thing is to be sick and stay home and kind of stay isolated. You need to be very active. You need to participate, whether it's groups or your normal social setting. Then there's also things like just relaxation, meditation, staying physically active, exercise as well as tolerated, things like that that are really going to help keep your mind going.

There is some thought that there are some medications like SSRIs or treatments for depression or anxiety that may help because there's some thought that it could be stress or anxiety-related. Not a lot of true effectiveness noted with like Ritalin or Alzheimer's like memory medications, things like that. People have tried it, but it doesn't really work. And then there are a bunch of herbal recommendations like Gingko, that really don't have any evidence whatsoever of working.

Host: And Dr. Ahmad, are there any other ways, in your opinion, strategies to manage this chemo brain?

Dr. Haroon Ahmad: Yeah. A lot of it is really just sort of tuning the person up. So the first thing I do if someone comes to me complaining of chemo brain is really to make sure we're not missing something else, right? So the first thing I'm going to say is, "Are you sleeping well enough at night? Do you have good uninterrupted sleep? Are you physically active? You know, are you maintaining three meals a day, staying hydrated, all those good things?"

Then, you know, we dig a little bit deeper and talk about, you know, are you having any feelings of depression, anxiety, things like that. So really I want to address those things first and try to optimize or tune up the patient as best we can. And then, you know, and this is the part where I really like to piggy back off what Katie said is that it's incredibly important to keep the brain active and, you know, keep physically active. I often tell my patients, "I would much rather have you, you know, go for a long walk in the park and then be tired and come home and take a nap rather than, you know, be on the sofa all day." And that's more of a physical example, but the same goes for cognitive as well. I'd much rather see someone continuing to work part-time, you know, try to keep reading. Some people ascribe to brain games on their computer. I won't say any specific name brands, but, you know, there's a lot of stuff out there that, you know, can keep people sort of mentally engaged and that's definitely one of the best defenses we have against chemo brain.

Host: Wonderful. And Katie, is there any way that chemo brain can be prevented or is there a way to decrease it?

Katie Arensmeyer: That's a good question. And to be completely honest, I'm not aware of any way. I think doing pretty much what Dr. Ahmad and I just kind of said, the whole staying active, keeping your brain going. And I think recognizing when you are under too much stress, and if maybe you're not really dealing with the diagnosis and the treatments and things like that. So that if we need to do an intervention, we can, such as, you know, antidepression or sending you to counseling, something like that. But as far as like, actually preventing it, we don't know enough about it to have a concrete answer on that.

Dr. Haroon Ahmad: Yeah. And if I could just pop in and say one thing, a lot of my patients will ask about memantine, which is a very specific medication that has been shown in some instances to improve cognitive function. That's really only been shown to be efficacious in the case of radiation therapy, which Katie and I will often lump chemoradiation brain versus radiation brain versus chemo brain, you know, one big diagnosis. But that's been used very specifically in one study to have some evidence to prevent chemo brain, but not really something we can generalize across, you know, multiple different types of chemotherapy that memantine would help.

Host: Gotcha. Okay. And Katie, as we wrap up here, do you have any last takeaways for listeners who might be dealing with chemo brain, have someone they love dealing with this.

Katie Arensmeyer: Honestly, I think the most important thing is to know that as Dr. Ahmad said, it is real. So patience, patience with yourself or your loved one, write things down, come up with different ways of dealing with it when you notice whether you're feeling foggy or having memory issues. Be patient and try and work around it. And hopefully, it's something that will be reversible. And once you're off treatment and things kind of settle down, it'll get better.

Host: And Dr. Ahmad, same question to you. Any final thoughts?

Dr. Haroon Ahmad: Yeah. Yeah. I have to underscore that it is a real thing, you know, just to get nerdy for a second, we have very real data now. You know, I think it was Michelle Monje's paper that shows structural damage or -- not damage, but sort of decreased regional volumes of white matter in the brain for people who've had chemotherapy. We've also had studies that looked at, you know, PET scans of pre- and post-chemotherapy, and there's just decreased activity in the brain in certain regions.

So it's very real. We don't know the exact mechanism. Some people say it's, you know, from cytokine dysregulation, which is sort of like an inflammatory marker. But I think that it's important for patients to know it's real and to give themselves a break and say, you know, "Hey, I can't keep up and I need to grab some help," you know, rather than try to plow through it and, you know, try to mask things. Because oftentimes, you know, there is something we can fix. It may not be fixing chemo brain, but you know, at least once a week, I see someone in clinic where they'll come in and they'll say, they're having trouble with cognition and it's really that they're having some reactive depression or really it's just that they're not sleeping through the night and not really tuning themselves up.

Katie Arensmeyer: So I would say take home point for patients is reach out early, reach out often. You know, you know your brain and body better than anyone else. So if something's not adding up or if something's not the way it used to be, you know, reach out and have that evaluation.

And the last point I'll make is there is also a formal evaluation that can be done. There's something called neuro-psychological testing, which it is a bit of a beast. It's a three- or four-hour test that our neuropsychologists do that tests multiple different cognitive domains. And they are quite good at pinpointing, you know, "Does this person have trouble with...? Is it concentration? Is it short-term memory? Is it executive planning?" And they can really kind of help us hone down on, "Okay, I know there is a million brain games out there, but this might be the one to focus on. This might help us out" or, you know, "These are all from depression," things like that. So there are tests that can be done. So it's not like it's a non-fixable entity that, you know, should be ignored by any means.

Host: Wow. Well, it's great to hear that there are so many options if someone is experiencing this. Well, thank you both so much for joining us today and for doing the work that you do. It was a pleasure having you both on the show.

This episode is sponsored by the University of Maryland Cancer network led by the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, one of the nation's NCI-designated comprehensive care centers. The UM Cancer Network provides access to national experts, the latest treatments, leading edge technology and promising clinical trials, all close to home. The UM Cancer Network, helping you beat cancer once and for all. You can find more shows just like this one at umms.org/podcast.

Katie Arensmeyer: Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.