Chemotherapy causes neuropsychological sequelae and cognitive losses in a large number of people. It is a phenomenon widely demonstrated and baptized by experts as chemobrain or chemobrain but, nevertheless, it is hardly talked about, not even in oncology consultations.
“They tell you that you can suffer from dizziness, vomiting, tiredness…, but no one warns you about memory loss and, when you suddenly see that you are unable to read even the simplest magazine, that you cannot retain what you are seeing in a movie or the words don’t come out, you get very frustratedâ€, says Tania Morell, who underwent chemotherapy last year to treat ovarian cancer.
And his is not an isolated case: “Those who have passed it know it; I was warned by the volunteers that Dexeus provided me to talk about his experience, â€says Morell.
The most common effects are attention and concentration deficits that affect memory, learning and reasoning and have an impact on visuospatial abilities.
“Patients explain that they don’t know where they have left their cell phone or keys, that they lose the thread of the conversation or the words they want to say do not come out, that they are not able to remember a movie they have just seen, that they process information in a slower way, that they are not able to do another activity at the same time as talking or that they cannot maintain a mental activity for a long time… â€, sums up Sandra GarcÃa Lumbreras, psychologist at Dexeus Mujer.
There is proven evidence that several drugs used in chemotherapy affect the stem cells of the central nervous system, which cross the blood-brain barrier, and neuroimaging tests show involvement of the white matter of the brain in people who suffer from chemobrain.
However, Carmen GarcÃa-Sánchez, a neurologist at the Dexeus university hospital and the Sant Pau hospital, assures that it is not known for sure what the chemobrain is due to, nor why the same treatment impacts each patient differently.
It has to do, he explains, with the fact that chemotherapy also modifies other biological processes such as the immune response or hormonal changes. And he adds that they have observed that the cognitive deterioration caused by chemo is also influenced by other factors, such as fatigue, aging, menopause, stress, difficulties sleeping… It tends to appear more frequently in haematological, colon tumors and lung, although where it has been studied the most and its effects are known is in treatments for breast cancer, because the affected population is very broad.
Studies indicate that these cognitive dysfunctions affect between 17% and 75% of those who receive chemo, “a variability that has to do with the instrument used to measure it,” explains GarcÃa-Sánchez, who together with GarcÃa Lumbreras has designed a free workshop to help alleviate the effects of chemobrain.
Because in relation to the cognitive deterioration caused by chemo, a turning point has occurred: more and more people are surviving cancer, who are cured and want to recover their lives before treatment and return to work.
“And that is where the suffering begins, because the person becomes aware of this deterioration in their abilities, they are afraid of not remembering things, of not being able to keep up with the work… And they ask for solutions,” explains Carmen Yélamos, head of psychological care of the Spanish Association against Cancer (AECC).
Laura Marco, a nurse from the Dexeus oncology committee, stresses that this change is very evident in the case of women. “Breast cancer is one of the most frequent, also one of the most cured, with many cases among women of working age and with intellectually demanding jobs; and when they want to get their life back after they have overcome the disease and see that they cannot, these women do not settle, they look for solutionsâ€.
This is the case of Aina Gomila, who has finished her chemo. Her tests indicate that she is cured of ovarian cancer, but she still cannot return to her position as a psychologist in a special education school due to her memory problems. “In the third chemo session I already realized that something was happening, she noticed me confused; The oncologist told me that it was normal, the result of the chemo, but when it was over she kept having to write things down for me, and I looked for strategies to recover â€.
This demand for answers and solutions from Gomila, Morell and other patients like them has caused some centers to begin offering therapies to improve cognitive function after chemotherapy sessions.
At Dexeus Mujer, for example, they have debuted with a free eight-session workshop (two per month) to work on affected cognitive functions and facilitate breathing, relaxation and rest techniques, as well as strategies that can favor patient adaptation to your working life.
“In each session we have worked on a different function: memory, calculation, orientation… with exercises as different as reading a book, drawing, doing puzzles or playing games; And in just three months I have noticed a lot of improvement: my head doesn’t work like before and the noise still makes me dizzy, but at least I can now readâ€, Morell says after completing the therapy.
Gomila, who shared sessions with her, believes that the value of these interventions goes beyond the exercises that are practiced. “It gives you the opportunity to talk about what is happening to you, to see what is happening to others, to be able to do something to improve yourself, and to learn strategies to better cope with the difficulties you now have to do things that seemed simple before. â€, she sums up.
The AECC psychological care team, which until now carried out specific actions against chemobrain, has also designed a therapy of between 8 and 10 sessions.
“Since last year we have been working on a protocol for intervention and cognitive rehabilitation and emotional and psychological rehabilitation; we work to stimulate certain brain areas and processes, but also healthy habits and psychological discomfort, because when exercise and rest are addressed, when fatigue and emotional problems decrease, we see that the result of the cognitive intervention is reinforcedâ€, explains Yélamos .
On the other hand, neurologists observe that there is a great similarity between the symptoms of chemobrain and the “brain fog” and fatigue reported by people who suffer from persistent covid, which leads them to think that this type of stimulation and rehabilitation therapies cognition could also be useful for this other group of patients.
The results of these interventions vary from one person to another, because the affectations are also different. “The subjective assessment is very good, all the patients report an improvement in their abilities, but there is a lack of objective studies on the recovery of cognitive functions; some previous work on chemobrain suggests that 35% of cases persist at 10 years”, points out the Garcia-Sanchez Dr.
