Wilmot Cancer Institute scientists have already discovered that “chemo brain” is a substantial problem that can linger for six months after chemotherapy ends. A new, $3 million grant ensures the research will continue — with the next questions focusing on whether the cognitive decline can continue for up to 10 years and how best to treat it.
Michelle Janelsins, Ph.D., a neuroscientist who later pivoted to clinical cancer research, is the principal investigator on the five-year National Cancer Institute award.
“There are so many interesting things to look at,” Janelsins said. She mostly evaluates chemo brain in women with breast cancer, and is also trying to untangle the roles of menopause and routine age-related cognitive decline.
“Cognitive impairment has a huge impact on a person’s daily functioning: how to manage the work/life balance, finances, social life. One of the most important questions to me is: How long does it last after treatment and what cognitive domains are most affected?”
Chemo brain is estimated to impact 80 percent of cancer patients and survivors.
For years, many oncologists were skeptical that the chemotherapy side effect existed, preferring to focus on attacking the cancer.
But in 2016 and 2018, Janelsins published the largest studies to date showing that it’s a pervasive issue. In addition to fogginess and memory problems, patients often report difficulty with concentration, with visual memory skills, and with sustained attention.
Also in 2018, Janelsins showed that inflammation in the blood may play a key role in chemo- brain symptoms. She began parsing her data to better understand the biological mechanisms and whether treating inflammation with over-the-counter medications, supplements or exercise might help.
A survivor’s perspective
Dawn Schnell believes that chemo brain is “100 percent” real.
“It felt very similar to ‘pregnancy brain,’ ” says the 46-year-old breast cancer survivor and mother of three, who lives in Pittsford, N.Y. “There was a loss of words and many of those moments when I’d be thinking: ‘Okay, why did I just walk into this room?’ “
She and her friends have joked about chemo brain, but Schnell also wanted to be part a possible solution.
While Schnell was having cancer treatment, she agreed to participate in two of Janelsins’ clinical studies. It was a time-consuming commitment that involved submitting to imaging scans of her brain, tracking steps on a pedometer, and undergoing difficult cognitive tests.
Schnell also recruited a friend and a neighbor to volunteer for a control group of healthy women, allowing researchers to compare the cognitive test results of those who received chemotherapy to those who did not.
“It was a really good experience,” Schnell said. “It’s important to give back and I hope and pray this will be helpful to someone.”
The results of Janelsins’ research will help scientists to understand how brain function changes over time in cancer patients who took chemotherapy, compared to a control group of healthy people, and how the brain fogginess and memory lapses impact the daily functioning of women as they age. The study will be conducted at sites nationwide in partnership with the National Cancer Institute’s Community Oncology Research Program (NCORP).
Tips for Coping with Chemo Brain
A national support group called CancerCare recommends that cancer survivors struggling with chemo brain should: make lists and use planners to keep track of daily tasks and upcoming events, get plenty of sleep, keep the brain active but read and do work in an uncluttered and peaceful environment, exercise, talk to loved ones about what you’re going through, and seek help from an oncology social worker if needed.
Increasing awareness of chemo brain is important, Janelsins said, with 17 million cancer survivors in the U.S.
To that end, she is the academic principal investigator on another project, led by a Boston-based company and funded by an NCI Small Business Innovation Research grant. The goal is to use special technology to quickly assess a patient’s cognition at the start of physician appointments through the electronic medical record system. The results are then communicated back to the medical team, electronically.
Although the test is not meant to serve as an official clinical diagnosis, Janelsins said, it may prime doctors to talk to patients about their cognitive symptoms and offer integrative oncology services or referrals.
“Regardless of the cause of chemo brain, whether there’s a psychological dimension or a biological dimension — and I suspect there’s both — it’s important in a person’s life for their functionality,” Janelsins said. “And understanding the different biological pathways that contribute to chemo brain will help us come up with the right interventions.”
Janelsins is an associate professor of Surgery, Neuroscience, and Radiation Oncology at the University of Rochester. She is part of the Cancer Control and Supportive Care research program at Wilmot, and leads the Cancer Control &Psychoneuroimmunology Laboratory.