Two weeks ago, I was fortunate to be involved as a presenter, along with a group of dynamic, international and interdisciplinary cancer care providers, for a workshop on Cancer Related Cognitive Impairment at the annual Society for Integrative Oncology (SIO) conference. I have summed up some of our findings for this blog post, which follow.
Cancer related cognitive impairment (CRCI) refers to changes in cognitive processing from cancer treatments which can involve memory, learning, concentrating, speed of processing, and even coordination of movements often leading to adverse effects on everyday tasks and quality of life. While the prevalence of CRCI is quite common, estimated to occur in about 75% of cancer survivors, it is still unknown exactly what causes it and there is no consistent way to diagnosis or measure it. Some studies have found that up to 40% of patients had some form of cognitive impairment following cancer surgery prior to starting systemic therapy (e.g., chemotherapy and/or hormonal therapy). About 35% of individuals have lingering symptoms for months to years following treatment.
While CRCI is often thought of in relation to chemotherapy, commonly referred to as “chemobrain”, it is also associated with hormonal therapies and radiation treatments to the brain. There are a number of theories about the physiologic changes leading to CRCI in addition to direct and indirect brain toxicity from cancer treatments, such as a genetic predisposition (e.g., presence of the APOE mutation associated with Alzheimer’s Disease), effects of inflammatory chemicals on the brain, blood vessel changes in the brain altering blood flow, and reductions is estrogen and testosterone. Both blood tests of various biomarkers and functional MRIs (fMRI) of the brain have shown changes that appear to relate with some of the symptoms described with CRCI (e.g., attention and memory issues). Psychological explanations for CRCI include depression, anxiety, pain and cancer-related fatigue. Most likely these are factors that contribute to the worsening of CRCI.
Most of the studies addressing CRCI have been conducted in breast cancer survivors, however CRCI has been described in patients with colorectal, prostate, ovarian, and testicular cancer, as well as those with hematologic malignancies (i.e., leukemia, lymphoma, and myeloma) . Because there are no consistent ways to diagnosis this problem, health care providers often rely on the use of self-report questionnaires and other neuropsychological tests, but they have limitations and comprehensive neurological evaluations may not always be practical in clinical oncology settings.
Despite the challenges with diagnosis and assessment of this distressing problem, practical non-medication strategies exist to help reduce the burden of CRCI. While some of them include the usual healthy lifestyle practices such as regular physical activity, healthy nutrition, and adequate sleep, others are more specific such as acupuncture, yoga, Qigong, meditation, relaxation breathing exercises, and cognitive training often with the use of computerized programs.
In a recent study among breast cancer survivors, acupuncture was shown to improve CRCI based on self-reported questionnaires and it was also related to higher levels of a blood biomarker called brain-derived neurotrophic factor (BDNF), compared to pre-treatment with acupuncture. BDNF is associated with neurological diseases such as depression, Alzheimer’s disease and Parkinson’s disease. Higher levels are associated with better cognitive functioning. Another study among breast cancer survivors found that yoga significantly improved perceived cognitive function compared to a group of breast cancer survivors who did not receive yoga. Another study tested Qigong, which is a gentle movement exercise involving controlled breathing and meditation, and findings revealed improvements in perceived cognitive impairment, as well as a reduction in an inflammatory blood marker called C-reactive protein. Lastly, the evidence on cognitive training utilizing computerized programs indicates significant improvements in cognitive functioning, especially with memory, executive functioning and speed of processing. Some of these programs are commercially available and can be done in the convenience of one’s home, while others must be used as part of a program with a trained professional. Two of the programs that are available for public use are Luminosity and BrainHQ. Although the number of studies using computerized programs is small, the majority were conducted with the BrainHQ program.
While further studies are needed to search for better diagnostics, assessments and treatments, at least there are some effective strategies available that can help improve the quality of life for those affected. Integrative health coaching can be very effective for helping with lifestyle changes around exercise, nutrition, sleep, and mind-body approaches. Some of the other treatment interventions are accessible through either cancer centers or cancer community programs, while the computerized programs can be done in the comfort and convenience of an individual’s home. Keeping the brain healthy is paramount to overall good health and wellness so if you know someone affected by this impairment please share this information with them.
To improved brain health!