Hormonal Therapy After Breast Cancer Surgery May Cause Long-Term 'Chemo Brain'

Menopausal women who take hormonal therapy after surgery for breast cancer may be prone to long-term “chemo brain” or cognitive decline, potentially benefitting from cognitive therapy or other interventions, according to study findings presented at the Oncology Nursing Society 44^th Annual Congress.

The study — presented by presented by Catherine M. Bender, Ph.D., RN, FAAN, a professor and endowed oncology chair in the School of Nursing at the University of Pittsburgh – found that women who take the standard five-year course of an aromatase inhibitor (AI) after breast surgery are left with lasting cognitive damage.

The study looked at 47 study participants with stage 1 to 3a breast cancer. One group was taking AIs alone (33 patients) and another took chemotherapy followed by an AI (14 patients). A third group (36 patients) included healthy controls matched to the other groups by age and education. The study compared results at one year post-therapy to baseline findings before AI therapy and to a final assessment taken near the end of the course of drugs.

Cognitive function was assessed before adjuvant therapy, twice annually in years one and two of therapy, annually in years three through five and once post-therapy. In assessing cognitive function, the researchers considered attention; concentration; verbal, visual and working memory; executive function; mental flexibility; and psychomotor speed (physical reaction time). That information was assessed along with age, education, IQ and levels of depression, anxiety, fatigue and pain.

Women who received AIs alone had poorer concentration and psychomotor speed one year after therapy compared with their scores before therapy. At the same time point, they also had poorer concentration relative to their last assessment during therapy. Healthy controls also experienced a decline in concentration at one year compared with their year-five assessment.

Other than that, women taking chemotherapy followed by an AI and healthy controls had improved executive function, attention, working memory and verbal memory at therapy completion relative to before therapy, and also at one year post-therapy compared with before therapy.

“Deficits in concentration and psychomotor speed may persist after completion of AI therapy in women with breast cancer,” the researchers concluded. “While these results need to be verified in a larger sample, they point to a need for interventions to help women compensate for persistent cognitive changes they may experience after AI therapy.”

Interventions for chemo brain can include counseling to teach compensation methods, such as the use of calendars and other tactics for planning and organization. Exercises for mental nimbleness can be done through computerized training programs such as Lumosity (Lumosity.com). Physical exercise can help, and doctors may also prescribe medicines such as those indicated for attention-deficit/hyperactivity disorder, Alzheimer’s or sleep disorders.

The study results also suggested that the disease itself, and not just its treatments, may be affecting cognitive function in women with breast cancer, Bender said. In addition, they indicate that concentration may be “the seminal domain” affected by breast cancer treatment, as without it, patients are unable to plan or organize.

Finally, Bender said that the findings “add to evidence suggesting that aging is accelerated in people with cancer…through multiple biological mechanisms.”