A Doctor's Read on the New Chemo Brain Treatment Study
Chemo brain, also known as cognitive impairment from chemotherapy, is a term frequently used by breast cancer patients and survivors to describe memory slips and general brain fog thought to be an after-effect of chemotherapy. In recent months, chemo brain has achieved a level of validation, at least in the realm of academic research and literature, more directly coming to the attention of doctors -- and patients who doubted the cause of their mental fog after cancer treatment. (See related New York Times coverage from April 29. 2007: "Chemotherapy Fog Is No Longer Ignored as Illustion.") For years, deficiencies in memory and IQ have been described in the surgical literature related to such procedures such as coronary artery bypass. Several small studies have shown that cytotoxic chemotherapy can cause impairment in cognitive function. Whether this is a short-term or a permanent deficiency is unclear.
Today, at the annual meeting for the American Society of Clinical Oncology (ASCO), a novel strategy to combat chemo brain was reported. The study conducted by Dr. Sadhna Kohli, assistant professor at the University of Rochester's James P. Wilmot Cancer Center, was the subject of ASCO merit award and selected for oral presentation -- an honor reserved for only the best research at the national meeting. Her study enrolled 82 women undergoing treatment for breast cancer and measured fatigue, speed of memory and attention.
In the first phase of the study, patients received modafinil over four weeks with 88 percent showing improvement in fatigue and cognitive function. Five patients dropped out because of adverse events related modafinil, and one patient had to be excluded because she had become pregnant. A second phase of the study took patients who had improvement during the four week test and randomized patients to modafinil or placebo.
In all groups that took the study agent there was an improvement in fatigue, speed of memory and power of attention. This is a landmark study that rigorously studies the benefits of the treatment of cognitive toxicity related to chemotherapy. Larger studies are needed to confirm the results, but the evidence is strong and will likely trigger "off-label" use. In addition, the ability to generalize this data to all patients receiving cytotoxic chemotherapy must be tested including patients of varying socioecomic, racial and ethnic backgrounds. Nonetheless, it is an exciting first step in treating an under recognized and likely common side effect of chemotherapy and will be the focus of significant research in the upcoming years.