Mayo Clinic doctor offers insight on chemobrain

moynihan

Dr. Timothy J. Moynihan, an oncologist at the famed Mayo Clinic in Minnesota, offers insights into chemobrain. His research ranges widely, and includes issues that are important to patients like quality of life and fatigue, and pain management. (A list of PubMed abstracts of his research papers can be found here.) He took time out of a busy schedule to do a Q&A with us.

Q. It seems like more and more clinicians are accepting “chemobrain” as something real. Yet many patients seem reluctant to talk about it. How should a patient approach their doctor if they believe they have “chemobrain” and he or she is not familiar with it?

A. I think more and more oncologists are aware that some proportion of people undergoing chemotherapy and or radiation therapy have some cognitive difficulties, that may be long term. The exact causes of these problems, the mechanism by which they are caused, the prevalence of these and how these can best be treated are the major areas of uncertainty. It is clear that not all patients experience these side effects. Why some and not others? Is it due to the underlying cancer, the treatment, other factors? So many things need to be discovered. So, if a patient is experiencing symptoms, he or she should just mention it to their physician. If the physician is not familiar with these neuro-cognitive changes, then requesting a referral to someone who has an interest, often at an academic medical center, is quite reasonable thing to request. This certainly may help to recruit patients for more studies of these side effects so we can understand what is occurring.

Q. What is your thinking about the potential cause of “chemobrain”?

A. I think this needs to be determined. Is it cytokine release from the tumor? Oxidative stress from the chemo? DNA or other chemotherapy damage? I do not think anyone is quite sure what the cause is at this point in time.

Q. Some patients have found relief by taking mild stimulants, such as modafinil. Do you recommend this course of action for any of your patients?

A. Ongoing trials are looking at things such as psycho stimulants. Certainly several trials have suggested some improvement in symptoms with these drugs. In patients who are really adversely effected by these symptoms it is something that we discuss and try to weigh the risks and benefits.

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.