“Doctor, Will the Treatment You Are Recommending Cause Chemobrain?”

Abstract

For more than a decade, patients and their oncologists have been sharing conversations about cognitive complaints after chemotherapy treatment. 1 Early on, only occasional patients complained of trouble with concentration and memory during treatment, with a minority noting persistence beyond the end of treatment. The oncologist, who rarely heard this complaint, could be dismissive, saying that the drugs the patient received did not cross the blood-brain barrier, and therefore, it was unlikely that the difficulties were related to the cancer treatment. Post-treatment cognitive complaints became much more evident during the late 1990s and early 21st century as adjuvant treatment regimens intensified and autologous bone marrow transplantation became more common in adults. 2,3 Often, cognitive complaints were associated with persistent fatigue and depressive symptoms, making it challenging to sort out whether or not the complaints of poor memory, attention, and difficulties with multitasking were related to brain dysfunction or were merely a manifestation of an uncontrolled mood disorder. 4-6 Many who complained were younger patients with breast cancer who had become menopausal prematurely with chemotherapy, and their experiences of vasomotor symptoms, nighttime awakening, and poor sleep might have explained some of their cognitive complaints. 7