Cognitive functioning in breast cancer patients

A new study on chemotherapy and its effect on the brain will be presented at the annual conference of the nation’s chief oncology group in Orlando. ASCO — the American Society of Clinical Oncology — has posted brief synopses of research, known as abstracts, online. (The meeting starts May 29. Late-breaking abstracts will be posted May 31.) The list is searchable by key word, and is good raw material for someone who wants to dive more deeply into the science of cancer and its treatment. At most conferences, new research is presented in several formats: as posters that are pinned up on boards in a large room, as an oral presentation on stage in front of an audience, or in a smaller panel or talk. The rigors of scientific research demand statistical analysis that may seem befuddling, even to those who took statistics in college. And researchers may use terms that seem arcane. But Google can be a powerful tool, making it relatively easy to search for definitions. Look for authoritative, official websites that have information vetted by doctors or researchers or science writers. For basics on cancer, or on study methodology, the National Cancer Institute website, found here, is clear and authoritative. Dig deep, and you can find an explanation for many medical and scientific terms.

One study being presented at the ASCO conference addresses cognitive functioning in breast cancer patients during and after chemotherapy. The study, done by researchers at the University of Rochester Medical Center in New York, was an outgrowth of another study of the antidepressant Paxil, which I blogged about here. Researchers looked at the changes that breast cancer patients reported over four cycles of chemotherapy, and then looked at how they were doing two years later. In all, 84 patients completed questionnaires about whether they experienced heavy headedness, muddled thoughts, difficulty thinking, trouble concentrating, or forgetfulness. (Patients filled out the questionnaires seven days after each treatment.) In all, 58 patients answered questions after all four cycles. Cognitive difficulties were highest after the first chemotherapy cycle, and were significantly improved by the third and fourth cycles.

But the researchers also found that there was an increase in cognitive difficulties AFTER the last cycle for a few patients — but not enough to be statistically significant. In other words, a very few patients found that their cognitive problems worsened after chemotherapy ended. Some patients reported improvements, and some reported no change.

The conclusion? The University of Rochester research suggests that cognitive difficulties related to cancer treatment are most pronounced after initial cycles of chemotherapy treatment, and that they improve during the treatment course.  As always, this research is simply a guidepost along the pathway, one more dollop of information that may ultimately lead to a deepened understanding of chemobrain. Better testing is needed — paper and pencil tests that allow doctors and patients to track symptoms, paired with brain scans and tests that measure other biological processes.

“Further studies need to include objective neuropsychological examinations and biological correlates of cognitive functioning to understand the extend of cognitive decline due to chemotherapy,” the researchers say.

Elizabeth Neuffer

NEUFFERI am packing up my office at the Boston Globe, preparing to move to the Broad Institute in Cambridge on June 8. A rush of memory and nostalgia is inevitable.  I found a French backpacking guide — wedged into the back of a bookcase — from a trip I took in 1995 with Elizabeth Neuffer, who was covering the war in Bosnia for the Globe. Neuffer, also a childhood friend of my partner, Ellen Zucker, was on hiatus from the war, taking time to tour with her father. By the time she met us in the south of France, she was ready for a few laughs.

We took the fast TGV train to Marseille, met Elizabeth, and, for lack of a better mode of transportation, asked a cabbie to take us to the French Riviera town of Cassis. As the cab lurched along, we picked an inn from Le Guide du Routard, the French backpacking guide we had bought in Paris. Elizabeth and Ellen Zucker both spoke French, and had no problem leafing through it. I could read a bit, thanks to years of high school Latin and numerous dinner-table quizzes about cognates. The cab dropped us at a rental car office outside Cassis, and Elizabeth and Ellen Z. haggled over the price of a tiny Renault. There was room for two adults and luggage — I lay across the luggage on the back seat. After a bone-rattling ride, our accommodations hove into view: The Hotel France Maguy, bright pink, with some rooms that went for the equivalent of $25 a night. Because it was off-season, and because it was perhaps on the low end of the luxury scale, we were the only guests and had our choice of rooms: small,  smaller, smallest. Some of the hotel doors were missing, but the Dutch hippie proprietors had put up colorful shower curtains in their place. That was fine by us. With no doors, and no guests to object, we could shout jokes between the rooms as late as we wanted.

We dropped our luggage and headed for town, where we bought bread, local cheese, tomatoes, olives, and a cheap rose. By now it had begun to rain, but we were determined: we had a picnic on the beach. Soaked to the skin and slightly tipsy, we got back to the Maguy to find that the proprietors had set out generous bowl-size lattes — a treat because we had put ourselves on a coffee diet in Paris to save money.

We had plenty of laughs, toured the craggy calanques on the coast, played boules on the town green — all in the incessant rain —  and got to know the owners of the Maguy over the next few days. The owners rode into town every morning on their bicycles and brought back fresh croissants and fruit for breakfast. We scoured the local flea markets and gossiped and generally tackled the problems of the world over numerous bottles of the local wine. It was a seemingly carefree respite, despite the rain, despite her father’s encroaching illness and despite the fact that she would be returning to her coverage of war and disruption.

Elizabeth, of course, went on to win numerous awards for her reporting in Bosnia and in Rwanda, including the Novartis Prize for Excellence in International Journalism and the Edward R. Murrow Fellowship from the Council on Foreign Relations. Her  book, “The Key to My Neighbor’s House: Seeking Justice in Bosnia and Rwanda,” documents her search for justice for the disappeared. She seemed to be in a place in her career where she was ready to give up reporting from war zones in favor of a more settled life. When the war in Iraq appeared to be winding down, in April 2003, she made a trip to report on the aftermath. The struggles and dreams of ordinary people had always interested her more than combat, at any rate. Always cautious, she ventured out on May 9, 2003, with a trusted driver and translator to Tikrit to gather string for a Sunday story on the Ba’ath Party. On the trip back to Baghdad, the car struck a guardrail. Elizabeth, 46,  and her translator, Waleed al-Dulaimi, were killed.

I recently stumbled across a link to a forum at the Kennedy Library where Elizabeth and Samantha Power talked about their work on genocide. The forum was in February 2003, three months before her death. The International Women’s Media Foundation, which gave Elizabeth the Courage in Journalism Award in 1998, established a scholarship in her name that continues to survive, despite the downturn in the newspaper industry. I often wonder what Elizabeth would make of the current state of affairs in journalism, her passion.  As someone wrote on the obituary website: When Elizabeth died, it was another bad day for the truth.

2009 Oncologists’ Meeting – Preview

ASCOOncologists gather in Orlando on May 29 for the annual meeting of the American Society of Clinical Oncology. ASCO posts short takes of studies, known as abstracts, online. I’ve combed through the list in order to highlight a few that touch on chemotherapy and cognitive dysfunction. I’ll present them here in small bites.

The first, from researchers at the University of Rochester Medical Center, examines the effectiveness of pharmacological interventions to control chemobrain symptoms. The researchers do not actually use the term chemobrain, of course. They call it cancer-related cognitive dysfunction, or CRCD. “Cancer and its treatment impact important areas of cognitive function such as attention and memory, which are essential to patients’ effective psychosocial functioning and quality of life,” the researchers report in their study, entitled “Neuroprotective effect of SSRI among 781 cancer patients receiving chemotherapy.”

From 17 percent to 75 percent of cancer patients report some difficulty with thinking and memory during and after treatment, the authors note. But few studies have looked at whether drugs prescribed for other ailments might help. This study, which is scheduled to be presented at the ASCO convention on Saturday, May 30, studied whether the antidepressant Paxil (paroxetine hydrochloride) helps with memory problems. Paxil, manufactured by GlaxoSmithKline, is an SSRI — selective serotonin reuptake inhibitor — that is commonly prescribed to treat anxiety disorders, among other conditions. (SSRIs help balance the level of serotonin, a neurotransmitter, in the brain.) The researchers gave patients a test to measure their memories. Patients who were tested ranged in age between 22 and 87 — a range that captures the brain in all its seasons. Of the patients tested, 574 were women, and 207 were men.

Patients were given the memory test after their first chemotherapy cycle and before being given Paxil, and then tested again after they had received four cycles of chemo and had been given Paxil. Some patients received placebos, or inert sugar pills, instead of Paxil. The researchers found a significant different between memory test scores before Paxil and afterward. Not surprisingly, they also found that Paxil relieved symptoms of depression that can also plague cancer patients before, during, and after treatment. (Other studies show that depression and stress can also affect cognition.)

The bottom line? The study says that cancer-related cognitive dysfunction “is a serious problem for patients that can be alleviated by Paxil. Future studies should examine the usefulness of other psychotropic agents and combined behavioral and pharmacologic interventions to control [it].”

Of course, this is one study of many that look at chemobrain. As always, no course of therapy should be undertaken without asking your doctor.

Chemobrain in the Irish Times

Lucy Atkins’s article on chemobrain for the Guardian in the UK struck a chord. It was picked up by the print edition of the Irish Times. Here are some reader comments.

Re: Cancer Fallout, Healthplus, April 28th

Dear Sir,

I read an article in Healthplus about cancer fallout which was very interesting to me as a cancer survivor.

Even though the section was about breast cancer, a lot of the after effects experienced by these women are similar to mine. I am a 28-year-old male who was diagnosed with non-Hodgkin CNS lymphoma in 2005.

Although four years on, this type of cancer is treatable, I went through all the treatment and am now in remission. But the fallout and side effects from it still make me worry that it might come back again because some of the symptoms that I presented with have not gone away, but the doctors have told me everything is fine from the scans that have been done.

As some of the women who had breast cancer and survived say in the article, the after effects of chemotherapy can be very difficult to live with.

Like the women who were describing some of the after effects of chemo on the brain, I too have had similar effects as well.

These include being forgetful and misplacing items, forgetting people’s names, etc. Sometimes I can’t remember certain things that happened just a few days ago – even if someone asks me if I remember certain things that we did last week.

Sometimes I have to go back to check whether I locked the front door when going out, only to find that I did, or having to check whether I rolled up the window in the car.

All these small things would drive a person mad. Sometimes when people are talking I have to say yes to them, to keep up with the conversation about something that happened. I could be trying to think of it, but just cannot remember it happening.

It can get so irritating at times that I ask myself is there something wrong with me that I can’t remember.

Confidence levels drop and sometimes one might get into a depressed state for a few days and get upset with people asking, “Are you all right, what’s wrong, can we help?”

You can get angry with yourself that you are unable to explain to them what’s going on when you don’t even know yourself why this is happening, but you get back out of this depressed state when something needs to be done.

There are also times, like now, where I have thought of something to say and I’ve forgotten it already.

Small little things like that can get a person down. Life can be difficult but we just have to keep going and try to put it to the back of our minds.

Any other information on chemobrain, or any information on where to obtain it, would be greatly welcomed.

Yours etc,

Conal Sadler,

Sheeaune,

Westport,

Co Mayo .

Dear Sir,

I had a mastectomy in August 2006 followed by chemo which finished in early 2007 – and to this day I can stop mid-conversation completely lost for a simple word.

I always say it is “chemobrain”, much more impressive than the so common “senior moment”! I do think it is a problem, much the same as being told that you may suffer from tiredness from chemo, whereas from what I gather it affects everyone.

Tiredness is not the right word for the utter fatigue I experienced.

Yours etc,

Anne Vaughan,

Templeville Drive,

Dublin 6W

Globe deputy editor going to Broad Institute – The Boston Globe