Little talk about it, but among the effects of ‘breast cancer‘there are also cognitive problems. It is not just some lapse of memory or forgetting why one entered that room. As we tell in the newsletter of Breast Health this week (here the link to sign up for free), it’s feeling foggy, asking the same question to the same person several times within a few minutes, it’s finding yourself disoriented or unable to hold a conversation. This is how the patients describe the so-called chemo-brain, the chemo fog. But, according to a review of the studies that have tried to describe this phenomenon and published in Psycho-Oncology, as many as one in four women report cognitive difficulties even before starting treatments.
Effects still to be investigated
Taking stock of the chemo-brain is not at all simple: there are not many studies, and very few are the longitudinal prospective ones, which investigate the differences in the cognitive sphere of patients before, during and after the start of a therapy. What then needs to be asked: which therapy? Most of the observations refer to the mental fog experienced by patients on chemotherapy, who appear to be the most impacted. Explanation? According to some evidence, some drugs can affect the integrity of the cells used to defend the central nervous system (microglia), creating a hostile environment whose final effect is to “compromise” the good transmission of nerve signals. “We know a lot less about the cognitive effects of radiotherapy and hormone therapy, which there are,” he says Agnese Losurdo, oncologist at the IRCCS Humanitas Clinical Institute in Rozzano: “But if radiotherapy and chemotherapy, however debilitating, are limited in time, hormonal therapies last for at least 5 years, sometimes reaching 7-10 years. any repercussions on the cognitive sphere can have a significant and prolonged impact on women’s lives – from job performance to home and family management, just to give examples “.
Don’t (just) call it chemo-brain
Furthermore, as anticipated, the analysis on Psycho-Oncology conducted by the researchers of the Utrecht Brain Center tells us that almost a quarter of women present cognitive problems before the start of therapies. Here, however, the data diverge: in some cases there is an improvement when the treatment path is defined, 24% of patients worsen further after the end of treatment and another 24% after a year. “These data underline how much we still need to study the chemo-brain and to understand what other factors – such as physical condition, hormonal changes, anxiety, depression and so on .. affect”, comments Losurdo.
Taking care of the cognitive sphere
As the authors write, monitoring cognitive functions over time appears crucial to identify patients who can potentially undergo cognitive decline and to support them through personalized cognitive rehabilitation. “As doctors, what we can do is remind ourselves to treat the person and not just his disease”, resumes Losurdo: “We must ask patients to also report these side effects to us if they arise, to keep a detailed diary to use as compass during checkups. And we must equip ourselves with more agile chemo-brain assessment scales that can be easily applied in daily clinical practice. Patients could also benefit from an integrated approach on the cognitive sphere – concludes the oncologist – mediation and support of psycho-oncologists who help to process one’s condition and gain awareness “.
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