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Spring Survey 2012 Results

“Chemo Brain” and Side Effects of Cancer Drugs

Program: Cognitive Challenges After Hormone Therapy
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Andrew Schorr:

All right. Now, I for my leukemia didn't have any hormonal therapy, yet I use this phrase "chemo brain" that we cancer survivors in blood cancers, we use this all the time. So will we get there too, that there might be just certain drugs that have more of that side effect on our ability to think clearly?

Dr. Cherrier:

Absolutely. In fact there are some studies ongoing now that are looking at that in animal models, where they're taking some of the chemo regimens and looking at mice or rats and giving them some of the cognitive tests that are appropriate, you know, for mice and rats and looking at those chemo regimen effects on cognition in animals. And there is definitely some indication that there are effects on cognition. Of course the big question there is how long do these effects last, and are they permanent. There is some encouraging research certainly by a colleague of ours, Dr. Karen Syrjala, in which looking out in transplant patients that if you look out five years past their treatment that there continues to be some recovery. So I do want to say that I think that's where we need to go, is we need to be following patient for longer so if there is recovery it may be five or ten years out but that there's hope that you'll continue to improve.

Andrew Schorr:

Dr. Higano, so you started by talking about the couples who come to you, and the wife says, you know, he's forgetting everything and he can't do some of the things he did before. So how are you beginning to talk to people now? So you're managing expectations, and if they've been married, you know, 30, 40 years and they have their idiosyncrasies, but the wife is worried that the guy, you know, not only is he fighting cancer but he's going downhill for good, what do you say?

Dr. Higano:

Well, luckily, honestly, we don't usually have that scenario where it's so severe. As a matter of fact usually there's kind of a question mark. Well, like, was this really going on before but now it's a little bit worse? So most of the time, every once in a while there is a severe situation, I'll get back to that, but usually it's just more of the same and only more so. And the first thing is to again explain and validate these observations that, yes, this is consistent with what we've seen in our studies. And depending on what this individual's problem is, that's where we're lacking on information on whether interventions such as certain brain games, you know, will it help you if you do a lot of crossword puzzles or Sudoku and so on. We don't know the answers to that, but certainly there is no reason to think that we couldn't use some of the strategies we use outside of the cancer setting for improving specific cognitive domains where certain functions need to be strengthened, if you will.

Andrew Schorr:

Now, you mentioned you wanted to point out maybe a more severe case and what you do then.

Dr. Higano:

These are extremely rare, and we don't always understand those. And, honestly, if I had a patient who, where his clinical situation was not life or death, you know, do we really need to give androgen deprivation, my approach would be to stop the hormonal therapy if it was really that bad. And in fact we have done this where we would see is there recovery that's consistent with the increase in testosterone and parenthetically, as Dr. Cherrier mentioned, estrogen levels, or not. Because sometimes what we've found is this deterioration is true, true and unrelated and actually was some ongoing process that was happening that had no relationship to the androgen deprivation, you know, because it didn't get better once we stopped and we were at a normal testosterone level.

Andrew Schorr:

Well, it's a fascinating area. So we mentioned there's a new study going on. How can people get involved, Dr. Higano?

Dr. Higano:

Well, we have a contact person that we can put on your website, and we will screen people. Actually, Dr. Cherrier works with Tom, Erickson, who does all the screening. And if patients are willing we'll get them enrolled right away assuming that they're eligible. Tom will actually travel if necessary to do some of the testing that's required because we're trying to minimize the problems that patients might have coming from long distances. So that's how motivated we are to do this research.

Dr. Cherrier:

Yeah. And I'd just like to kind of also emphasize the points that Dr. Higano was making which is that's why it's so important that we get a pretreatment baseline because it may be the case that these problems are preexisting. And so we often get calls from people who will say, you know, I'm on hormone therapy now, can I be in your study. And although we'd love to have everyone involved that way, it's just for us to do good science we really need to capture people before they start their treatments.

Andrew Schorr:

How about this? Maybe for people, like my dad used to play bridge, and he did take hormonal therapy, it would be great to say, Max, let's play bridge with you, then you're going to start your hormonal therapy, and then I'll come by your house and play bridge every month. He would have loved that. So just work out your strategies.

Well, thank you for explaining this, and I think it really validates what so many people I'm sure have thought, but it's subtle usually and you just don't know. And then also for both of you your commitment to helping get the answers. And maybe then better treatment approaches that can minimize this for men and then men and women with other cancers as well, that would be terrific. Thank you for what you do, Dr. Tia Higano. Thank you for being with us once again.

Dr. Higano:

You're very welcome.

Andrew Schorr:

And, Dr. Monique Cherrier, thank you. We'll have to talk another time about all your other memory research as well because as we all get older whether we're cancer patients or not, we're thinking about that all the time.

Dr. Cherrier:

Absolutely, yes. I'd love to talk with you more.

Andrew Schorr:

Okay. Well, thank you both for being with us. This is what we do on Patient Power. Thanks to the Seattle Cancer Care Alliance for working with us as we do this month after month. And, as always, remember, knowledge can be the best medicine of all. I'm Andrew Schorr. Thanks for joining us.

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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