HER2 Support Group Forums - TV News Report re: Evidence of "Chemo Brain"

When I was taking a shuttle from the San Antonio airport to my hotel I spoke briefly with a psychologist from Canada who worked with patients who had chemo brain. I thought she said she was presenting a poster at the symposium but I can't find it. Here are a couple abstracts from the SABCS that might be of interest. Note the last one deals with cognitive changes during hormonal therapy post chemo, perhaps another factor to consider.

Paula

[ES4-2] Cognitive Changes and Breast Cancer Treatments

Ganz PA. University of California, Los Angeles

Cognitive difficulties after cancer treatment are among the most feared outcomes voiced by patients who are approaching the start of chemotherapy. This phenomenon, sometimes referred to as "chemo brain" or "chemo fog," is quite common during the acute course of chemotherapy treatment. This may result from direct antieneoplastic drug toxicity, use of premedications and anxiolytics to prevent nausea and vomiting, as well as the expected anxiety, depression, and sleep deprivation that accompanies a new diagnosis of cancer and initiation of treatment. For most patients, this fog clears after the completion of acute treatments, and as with many physical symptoms, resolves in the following months. However, 15-25% of post-treatment patients, cognitive complaints persist long after treatment ends. Reports of difficulty concentrating, remembering recent events, multi-tasking, and paying attention are frequent in such patients. For those used to carrying on demanding executive function activities prior to cancer treatment, this can lead to substantial disruption in work and home life. Most of the studies conducted to date with early stage breast cancer have not accounted for the impact of adjuvant endocrine therapy alone or added to adjuvant chemotherapy. This presentation will review emerging data regarding self-reported cognitive complaints, neuropsychological testing, and brain imaging as they related to adjuvant therapies for breast cancer. In addition, some of the developing information about potential mechanisms associated with this late effect will be discussed.

Tuesday, December 4, 2012 4:00 PM

[P6-09-01] Investigating the Effectiveness of a Psycho-Educational Behavioral Intervention for Cancer-Related Cognitive Dysfunction in Women with Breast and Gynecological Cancer: Knowledge, Self-Efficacy, and Behavioral Change.

Bernstein LJ, Dissanayake D, Tirona KM, Nyhof-Young JM, Catton PA. Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, ON, Canada

Background: Approximately one third of individuals receiving chemotherapy for breast cancer experience cancer-related cognitive dysfunction (CRCD). CRCD significantly impacts quality of life, employment, and social relationships, and can hinder ability to return to pre-cancer activities. The cause is likely multi-factorial, and currently no medical treatment exists. The Cancer Survivorship Program at Princess Margaret Hospital provides a behavioral-intervention for patients with CRCD. The single, one-on-one, hour long session provides information and compensatory strategies to improve knowledge, self-management skills, and decrease the impact of cognitive dysfunction on daily life.
Methods: A mixed-method study assessed patient perceptions. Eligible women had been or were currently being treated for a diagnosis of breast or gynecological cancer and were English speakers. Likert-scale based questionnaires were administered immediately before, immediately after, and 6 weeks post-intervention. Six parameters were evaluated quantitatively: i) program delivery, ii) perception of knowledge, iii) distress, iv) self-efficacy, v) behavior change, and vi) behavioral change effectiveness. Ten individuals also participated in qualitative, semi-structured audio-recorded interviews 1-6 weeks post questionnaire completion. Responses were analyzed using the constant comparative method.
Results: 72 female cancer survivors (61 breast; 11 gynecological; mean age 51.3) completed questionnaires. Immediately post-intervention, patients reported significant increases in perception of knowledge, self-efficacy, and decreases in CRCD-related distress, and these improvements were maintained at 6 week follow up (p < .01 in all cases). Participants reported numerous benefits associated with increased knowledge, including a sense of validation and reassurance, and increased confidence and success in managing their symptoms. No statistically significant differences in intervention effectiveness were observed as a function of patient age (older or younger than 50), education (greater or less than grade 12), or employment status (skilled worker or higher vs lower). However, individuals of low employment status were less satisfied with the volume of information in the intervention. Interviews indicated their preference for an additional session to reinforce the techniques discussed. Thematic analysis also indicated that adoption of new compensatory strategies was associated with a sense of control, confidence and pride for all patients; although barriers were identified for some that prevented long-term use (e.g. techniques take time and effort). Employment distress was mainly tied to difficulties with work tasks.
Conclusions: A one-hour, psycho-educational behavioral intervention can be effective for breast and gynecological cancer patients suffering from CRCD. Benefits can last at least 6 weeks. Results suggest a need for better intervention integration with oncology appointments, a follow-up session to help individuals assimilate CRCD information, and increased session personalization to address individual difficulties and job concerns.

Saturday, December 8, 2012 7:00 AM

Poster Session 6: Psychosocial, Quality of Life, and Educational Aspects: Psychosocial, QOL, and Educational Aspects – Other (7:00 AM-8:30 AM)

[P2-13-10] Prospective Randomized and Multicentric Evaluation of Cognition in Menopausal Breast Cancer Patients Receiving Adjuvant Hormonotherapy: A Phase III Study (Preliminary Results)

Vanlemmens L, Delbeuck X, Servent V, Mailliez A, Vanlemmens L, Lefeuvre-Plesse C, Kerbrat P, Petit T, Fournier C, Vendel Y, Clisant S, Bonneterre J, Pasquier F, Le Rhun E. Centre Mémoire de Ressource et de Recherche - CHRU Lille, Lille, France; Centre Oscar Lambret, Université Lille Nord de France, Lille, France; Centre Eugène Marquis, Rennes, France; Centre Paul Strauss, Strasbourg, France; Centre Oscar Lambret, Lille, France; CHRU, Lille, France

Background
Cognitive impairment has been considered to be a possible adverse effect of aromatase inhibitors (AI). The aim of the study was to compare the impact of tamoxifen or AI on verbal memory (Rey auditory-verbal learning test) and other cognitive functions (memory, executive and attentional functions) after 6 months of treatment.
Methods
In this randomized, open-label phase III study, menopausal patients treated with adjuvant hormonotherapy for early breast cancer were enrolled at the end of the radiotherapy. Patients over 70 years, with a history of cognitive disorder or with prior chemotherapy were excluded. Detailed neuropsychological assessments and quality of life evaluations were performed before the 1st administration of hormonotherapy and then 6 months later. Considering the usual norms of the auditivo-verbal Rey test, an alpha risk of 5% and a 95% power, 27 patients per arm had to be included. Statistical analyses included Chi2 test and Student tests when appropriate.
Results
62 consecutive evaluable patients were randomized in 2 arms between March 2009 and April 2011. Patients received tamoxifen in arm A (n=31) and AI in arm B (letrozole n=17; anastrozole n=12; exemestane n= 2). Median age at inclusion was 61.4 years. The median time since menopause was 10 years. Characteristics of the breast tumor and initial neuropsychological evaluations did not differ significantly between the 2 arms. After 6 months, we observed a significant decline of the performance at the episodic memory test (immediate recall of the Rey auditory verbal learning test) (p=0.0015) in arm A only and a significant improvement on executive measures (Trail Making Test and Stroop test) (respectively p=0.03/p=0.002) in arm B. Quality of life didn't differ after 6 months of treatment.
Conclusions
These preliminary results do not support that AI have a worse adverse effect on cognitive functions than tamoxifen after 6 months of treatment. A confirmation is planned after one year of treatment.

Thursday, December 6, 2012 7:00 AM

Poster Session 2: Treatment: Endocrine Therapy – Adjuvant (7:00 AM-9:00 AM)