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Know a client's cancer treatment history

September 1, 2008
by Ralph E. Jones
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Neuropsychological effects of chemotherapy can complicate the recovery picture

People in cancer recovery groups and chat rooms are actively engaged in sharing problems associated with the treatments used for their illnesses. Not long ago these difficulties were considered a function of patients' imaginations, and patients' concerns often were discounted. Yet through further investigation, oncologists and others in the cancer treatment field have acknowledged the symptoms as being genuine.

It is not uncommon in studying some cancer patients to hear of memory and cognitive problems such as finding multiple unopened gallons of milk in the refrigerator and having no memory of buying them, or not remembering how to carry over numbers when balancing the checkbook, or suddenly not knowing the time, date, or day of the week. Many patients also have experienced emotional swings, delusions, depression, anxiety, and other symptoms. The common thread in these cases is having received chemotherapy and subsequently experiencing a phenomenon now commonly called “chemo brain.” This phenomenon is relatively unknown to addiction professionals, but can complicate ongoing recovery for individuals who have undergone cancer treatment.

There is great awareness of the physical symptoms associated with chemotherapy treatment (including but not limited to loss of hair, nausea, anemia, appetite changes, fatigue, and nerve and muscle problems). But professionals are less familiar with mental effects manifesting as “chemo brain.” The term was first coined by patients who were undergoing chemotherapy, or the various infusions of toxic drugs to kill or control cancer cells.

It had been thought that medications used in chemotherapy did not pass through the blood-brain barrier as many illicit drugs do. But in recent years, it has been discovered that a certain amount of the chemotherapy drugs do slip past the barrier. The mechanisms for chemotherapy-induced cognitive changes remain largely unknown, yet several candidate mechanisms have been identified. It has been suggested that shared genetic risk factors for the development of cancer and cognitive problems, coupled with the effect of chemotherapy on these systems, might contribute to cognitive decline in patients after chemotherapy.1 Studies in Japan found that chemo brain appears to be related to a reversible shrinking of brain structures induced by chemotherapy.2 Chemotherapy can have a direct effect on the central nervous system and also can cause cognitive problems through indirect effects, such as a reduction in estrogen and testosterone concentration.3

The impact on recovery

It is not possible to predict who will experience cognitive impairment after chemotherapy. Also, it would be rare indeed to find a person in addiction or cancer recovery who has not experienced symptoms of depression and anxiety to some degree. Once entering into chemotherapy treatment, however, these individuals see that their symptoms are usually exacerbated and are joined by other mental difficulties, often as a result of the medications used in the chemotherapy—of which there are currently nine groupings of more than 360 drugs.

For example, men who undergo prostate cancer treatment with hormonal medications to reduce the testosterone that cancer cells thrive on often receive Lupron, a medication with several side effects associated with long-term use (including anxiety, delusions, depression, and extreme changes in mood). In general, the Physician's Desk Reference (PDR) information on the various chemicals given in chemotherapy generally concentrates on physical side effects as opposed to possible neurological effects.

Juan Hernandez, a licensed professional counselor in Texas with 16 years of experience in the hospice counseling arena, has met with hundreds of patients having undergone chemotherapy. Having seen the symptomology previous listed, he also relates that many people act out of character, as if undergoing a personality change. He finds that patients often become suspicious about their spouses and others in their lives as part of a delusional thought process. Not only is the abuse of prescription medication more frequent with these individuals, there is also a higher risk of consuming alcohol and/or illicit drugs, he says.

Of course, the survival benefits of chemotherapy far outweigh the potential risks to cognitive functioning and other mental difficulties for most patients. But unfortunately, many of these memory and cognitive problems also can persist for years after treatment has been concluded.4

Christina Meyers, PhD, chief of neuropsychology services at the M.D. Anderson Cancer Center in Houston, relates that “in these cases, individuals may be embarrassed and even ashamed—feeling they should be thankful that their battle with cancer is over, instead of being distressed by a ‘memory problem’ in the context of an otherwise successful outcome.” She adds, “Unfortunately, cognitive symptoms can lead to emotional distress and impede a patient's ability to successfully meet scholastic, vocational, and social goals.” These cognitive deficits can affect a patient's ability to make informed treatment decisions.