Clinical trial at Memorial Sloan-Kettering Cancer Center

ClinicalTrials.gov reports that researchers are conducting a large clinical trial designed to learn more about how chemotherapy affects the ability to think. Specifically, doctors at Memorial Sloan-Kettering Cancer Center in New York City want to know whether chemotherapy agents damage the DNA of women treated for breast cancer, and whether DNA damage is related to problems thinking.

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This kind of research, with a large enough group to be statistically significant and a group of healthy “control” subjects, is ultimately going to drive the science of chemotherapy and cognition to a new level. In other words, trials like this may give doctors new insights into cancer treatment and brain function that could help the millions of breast cancer survivors in the United States. It might also translate to other cancers, too.

“Some research has shown that chemotherapy can cause changes in cognition [thinking] in breast cancer survivors,” the doctors write. “However, it is not clear why this change occurs. In this study, the investigators will look to see if damage to DNA is related to these changes in cognition.”

Doctors hope to enroll 150 women, all between 50 and 70 years old, at three different MSKCC sites: in New York City, in Commack, New York, and in Rockville Centre, New York.

The study, which began  in June 2007, will be completed by June 2010. Women participating in the trial will be divided into three different groups, according to the information posted on ClinicalTrials.gov:

  • Breast cancer survivors 2-6 years post-treatment who were post-menopausal at the time of diagnosis and treated with a combination of chemotherapy and hormonal therapy.
  • Breast cancer survivors 2-6 years post-treatment who were post-menopausal at the time of diagnosis and treated only with hormonal therapy.
  • Healthy women.

All participants will be given a mini “mental state exam” — a neuropsychological test that takes abou 2 hours to finish. Blood samples will also be drawn. Participants will be matched by age and education, as well — allowing researchers to draw valid, apples-to-apples comparisons.

ahles2The researchers conducting the trial, Dr. Tim Ahles and Dr. Denise Correa, write that “the primary objective of this proposal is to obtain preliminary data regarding the association between DNA damage and cognitive functioning in breast cancer survivors.”

They predict that breast cancer survivors treated with chemotherapy and hormonal therapy will have higher levels of DNA damage, compared with those treated only with hormonal therapy, and compared with the healthy women.

They also expect to find that those who show signs of cognitive impairment on tests will have higher levels of DNA damage.

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Tips from Mayo Clinic

MayoClinic.com, a website affiliated with the Mayo Clinic in Rochester, Minnesota, has an updated link on chemobrain. (The website is reviewed by Mayo Clinic doctors.)

There are simple, nonmedical steps you can take immediately to begin coping, at work and at home. Some of their tips:

  • Control what you can about your working environment. If noise and commotion are contributing to your distraction, try to find a quiet corner where you can concentrate. Soft music may help drown out other noises.
  • Prepare yourself for success. Before tackling a complicated task that requires concentration, take steps to ensure that you will have the best chance for success. Eat so you won’t be distracted by hunger. Pick a time of day when you’ll be the most alert. Get a good night’s sleep. Have a plan so you know exactly what you’ll need to do in order to complete your task.
  • Stay organized. Use calendars or planners to keep on task. That way you won’t spend time wondering if you’re forgetting an appointment or an item on your to-do list. Write everything down in your planner. Make organization a priority at home and at work, too. Having an organized work space means you can spend more time on tasks that you need to accomplish.
  • Clear your mind of distractions. When distracting thoughts pop up, write them down in your planner. Recording your thoughts will help to quickly clear them and ensure that you remember them later.
  • Take frequent breaks. Divide your tasks into manageable portions and take a break each time you complete one part. Give yourself a short rest so that you’ll be able to continue later.
  • Exercise your brain. Try crossword puzzles or number games to exercise your brain. Take up a new hobby or master a new skill, such as learning to play a musical instrument or learning a language.
  • Exercise your body. Moderate exercise, such as brisk walking, can help you cope with stress, fatigue and depression. All can contribute to memory problems. If you haven’t been active lately, get the OK from your doctor first. Start slowly and work up to at least 30 minutes of activity most days of the week.

Kate Jackson’s Pointy Universe

katejacksonGlobe writer Kate Jackson blogs about her treatment for breast cancer (invasive ductal carcinoma in situ, stage III, to be exact.) Kate’s vibrant personality and lively writing are all here, plus an ongoing peek into her eclectic iPod playlist. (Kate wrote a much-talked-about piece for the Globe on the meaning of pink Red Sox hats, a debate that will begin anew at Fenway Park when Red Sox season opens with an afternoon game against Tampa Bay on April 6. This debate tends to split along gender lines. (Why are pink hats any  less inauthentic than the green hats that pop up on St. Patrick’s day? You can read her piece here.)

Crossing the medical/media barrier

 

When I began researching chemobrain in January 2007, it was clear that the field of study was in its infancy. There was a growing body of serious research into what scientists call neurocognitive late effects — and this research was exploding all over the world. But some cancer patients and survivors I talked to still reported that their doctors dismissed their complaints. 

As Dr. Harold Burstein at the Dana-Farber Cancer Institute in Boston told me, chemobrain is part of the lore of breast cancer, and any clinician who sees breast cancer patients has heard the term — and, he says, has heard patients talk about  this bedeviling cluster of symptoms. Preparing a PowerPoint presentation in 2007 for the 10th International Conference on breast cancer therapy in St. Gallen, Switzerland, he did what he calls “a highly unscientific survey” of 24 of his breast cancer patients. Eighty percent of them told him that they believed that chemotherapy had made it harder to concentrate or remember names. Some had particular trouble with numbers, others could not follow a single train of thought for long. Many felt spaced out and easily distracted.

However, he added, the literature is messy — at least, the literature that doctors pay attention to. Think of the difficulty in comparing apples and oranges: some studies follow a group of people over a long period of time, other studies are a snapshot of a particular moment. Cognitive tests are designed differently. (And sometimes the tests themselves are daunting — could you complete a drawing of a geometric figure while stuffed inside a claustrophobic MRI tube?) 

But that is changing. Researchers are designing controlled studies and experimenting in the lab, and publishing scores of new articles in peer-reviewed journals — the gold standard for scientific work. Researchers like Christina A. Meyers, PhD, and Jeffrey Wefel, PhD, at the M.D. Anderson Cancer Center in Texas, Tim Ahles, PhD, at Memorial Sloan Kettering Cancer Center in New York, Sanne Schagen, PhD, at the Netherlands Cancer Institute in Amsterdam, and Robert Butler, PhD, at Oregon Health & Science University in Portland. (Dr. Butler, who specializes in pediatric hematology and oncology, was cited with gratitude by many parents I interviewed. He listened to them. He helped them find answers. More on late side effects in teen-agers in another post.)

113754-prometheus It’s seeping into websites and into the popular press — what the rest of us non-doctors read. Although no one should begin, end, or alter their treatment based on a newspaper article, the media echo chamber helps push patient empowerment movements forward. My colleague at the New York Times, Jane Gross, called attention to chemobrain with an important front-page article in April 2007.

When medical research collides with a burgeoning patient empowerment movement, the results can be powerful. So let the conversation flow.

Chemobrain and MENSA

esthipsynapses

A fellow Minnesotan writes about his lung cancer, and his thoughts about intelligence and memory. He also inveighs against the tobacco industry and its powerful marketing campaigns — and acknowledges that, yes, he smoked cigarettes.


I have read your book, ChemoBrain, and wanted to share my experience.   I am six years into remission from serious chemo and radiation treatment.  (You can read about my experience at http://sunweber.blogspot.com/)

When I was entering graduate school I had to take the Miller’s Analogies.  I missed only two of them out of 100, went through the questions twice and still turned it in when only 1/2 the time was gone.

This allowed me to get into MENSA.  My ability for all my life was to see patterns.  I could read various books on a subject, say the brain, without trying to memorize or learn for a course and end up with a decent knowledge of the subject.   This pattern recognition served me well as a psychologist.   I could hear a story and know the etiology as well as the missing or untrue parts because things from the storyteller’s perspective had to make sense.  Coupled with that I was very empathetic in the ability to walk in another shoes.  It was a gift but also a bane because I couldn’t not see the patterns of peoples’ lives. Also my writing skill was to think about something and then simply write it with very little need for editing afterward.

johnweber

After treatment, my pattern recognition went to hell.  Also my memory as you have recorded in your book but the loss of the pattern recognition was the most obvious to me.  Writing was arduous.  Emotionally, I literally felt in my body a reaction to someone’s tale of physical hurt.  Never had that before. To shorten this, I believe what was most effected was the amygdala and the hippocampus.  These limbic system parts of the brain deal with emotions and memory as well as are routing stations for these activities.

snapshot-2009-02-19-00-21-31

I don’t know if the actual structures themselves were affected or there connections going in and out especially to the frontal lobes.  Also my sense of smell became very acute which may have some connection the hippocampus. My faculties are slowly returning after six years.  Don’t know if it will ever be the same.  Also don’t know how much age is now playing a factor, I am almost 66.

When I brought up chemobrain/chemofog to my oncologist he shot it down.  I explained I was not complaining, I was glorious to be alive but it was definitely an experience.  I explained the MENSA connection and told him I probably would not qualify anymore.   I plan to give him your book. I am writing this both to thank you and if you wish to forward these thoughts to researchers.

JOHN WEBER

Longville, MN