Cancer Related Cognitive Impairment – Dr. Sandeep Nayak, Surgical Oncologist, India

When the news of cancer is broken to the patient, the patient’s emotional state takes a hit and is taken over by fear. The patient tends to take time to gather his/her bearing and make informed decisions.

It is not a disease that people can heal from after self-medicating and therefore feel that they are not in control of the situation.

They tend to surrender their well-being into the hands of their oncologists. Dr. Sandeep Nayak, one of the best surgical oncologists in India, says that the patients should make the efforts and stay involved in their day-to-day activities with elevated enthusiasm to fight the effects of brain fogging or what is commonly known as chemo brain.

Dr. Sandeep Nayak, specializes in robotic surgeries for cancer and is available for consultancy at fortis hospital and his pet project MACS clinic in Bangalore. 

The chemotherapy drug introduced into the system tends to show signs of confusion amongst the patients. The effect of the drug in combination with the patient’s already fragile state of mind may result in CRCI.

 What are the symptoms of CRCI?

The symptoms of chemo brain look like:

• The confused state of mind
• Inability to organize
• Losing concentration
• Groping for words
• Cannot adopt new things
• Multitasking is off the list
• Forgetfulness, including tasks, conversations, and visuals.

What are the causes of CRCI?

A cancer diagnosis makes a person anxious and depressed, leading to thinking and memory problems.

In addition to that, all the treatments administered to the patients for treating cancer can take a toll on their cognitive abilities.

When women were diagnosed with breast cancer back in the 1990s, it was noted and clinically reported that they suffered from cognitive impairment due to the chemotherapy, especially when they were administered high doses in a short span.

But it was also noted that these effects did not last long.

Instead, for many women with breast cancer, there has been a decline in the intensity of chemotherapy, and in fact, many women did not need chemotherapy in the intervening years. Many women with ER-positive breast cancer were assessed for the risk using a genome-based tool, and the reports suggested that only hormone therapy would heal them of their cancer.

Patients and, more slowly, their doctors have seen an increase in the occurrence of cognitive abnormalities. It has been noted that this condition is reversed, and they regain their cognitive abilities once the chemo stops and they heal from cancer, but so is the case when they are treated with radiation or hormone therapy.

Symptoms are usually noticed quickly after a cancer diagnosis, but they can last for years. Similar patterns have been observed in some persons who have been treated for other cancers, such as head and neck cancers, brain tumors, and lymphoma, and in some people who have had stem cell transplants.

Complex as it is, the issue cannot be attributed solely to the use of powerful chemotherapy medications. According to a recent study published in JAMA Network, 77 percent of breast cancer patients who had chemotherapy and 45 percent of those who only received endocrine/hormonal therapy developed cognitive problems during or soon after treatment.

Patients that are older or have other medical disorders such as heart disease or diabetes are likely to be more susceptible to CRCI.

Pre-existing psychological problems, such as a history of trauma and depression, are also thought to raise a person’s chances.

Stress, sleep, fatigue, and anxiety, all of which are common side effects of cancer treatment, appear to have a role in CRCI.

Your oncologist and doctor will listen to you closely about your mental concerns and reassure you that it is only a matter of time before you feel like yourself again.

An unrelated but extremely fascinating new study is that the brain fog that occasionally accompanies Long COVID may be akin to chemo brain. After chemotherapy, researchers discovered high quantities of cytokines and chemokines (proteins found in cells that govern immune responses) in people’s brains. One chemokine linked to cognitive impairments was found to be higher in patients with Long COVID brain fog than in those with no cognitive symptoms. We may learn more about CRCI due to the increased focus on the virus and its consequences.