Chemobrain: Research the Nurse Can Apply

JILL SHELTON, RN, BSN | October 07, 2016
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Treatment Options and the Nurse’s Role

Pharmacologic
Vitamin E shows some promise of improvement in verbal and visual memory while gingko biloba has not demonstrated cognitive improvement. Neurostimulants such as modafinil, FDA approved for treatment of narcolepsy, and methylphenidate, approved to treat ADHD, have been evaluated in small studies for cancer-related cognitive changes, but results have been mixed.2

Nonpharmacologic
Exercise is encouraged because of its ability to reduce inflammation and fight fatigue. Meditation, yoga, aerobic, and strength training are shown to have an impact, noted Krigel.

“With insomnia, anxiety, and depression, exercise helps.” For patients and survivors who are reluctant or say they don’t like to exercise, she suggested helping them find some activity they do like. Studies are under way to evaluate the impact of Qigong, a Chinese practice of physical and breathing exercises to determine whether it is the movement, the combination of movement and sound, or the support of being with others, that may be effective.

Cognitive training has been noted as likely to be effective, but the evidence around cognitive rehabilitation and behavioral training requires further study.2

Psychoeducation is also being studied, Krigel noted, for example, a 6-week intervention providing information on sleep, anxiety, depression, diet, exercise, and helping individuals learn about memory and strategies to improve their memory. Researchers are looking to see if such an approach can have an impact on patients’ level of perceived impairment and whether that impact persists.

“Nurses are in a great position to be able to help people figure out priorities because they know comorbidities,” advised Krigel. “Is this an anxious person? Are they depressed? How’s their sleep? Set priorities, help people figure out what the biggest priority is and start working with that, and keep touching base with them over time.”

Finally, Krigel suggested encouraging patients and survivors to try compensatory strategies, such as organizing with calendars, alerts, reminders, lists, and routines—these all can be helpful. Asking for help, practicing patience when forgetful, and acceptance of the situation are other strategies that may be helpful but take time.

Additional Resources
The advocacy group cancercare fact sheet “Coping With Chemobrain: Keeping Your Memory Sharp” is a helpful patient education resource offering practical tips you can share with patients and survivors.
References
  1. Krigel S. Series: Part 1: Chemobrain: It's Real, It's Complex, and the Science Is Still Evolving; Part 2: The Science Behind Chemobrain; Part 3: Patient Recommendations for Chemobrain. http://bit.ly/2dayEUs. Accessed September 28, 2016.
  2. Arash A, Myers JS. The effect of cancer treatment on cognitive function. Clin Adv Hematol Oncol. 2015;13(7):441-450.
  3. Natori A, Ogata T, Yamauchi, H. (2016). A piece of the ‘chemobrain’ puzzle: pNF-H. Aging. 2015;7(5):290-291.
  4. Ferguson RJ, McDonald BC, Saykin AJ, et al. Brain structure and function differences in monozygotic twins: Possible effects of breast cancer chemotherapy. J Clin Oncol. 2007;25:3866-3870.
  5. Merriman JD, Von Ah D, Miaskowski C, et al: Proposed mechanisms for cancer- and treatment-related cognitive changes. Sem Oncol Nursing. 2013;29:260-269.
  6. Fardel JE, Varcy J, Johnston IN, et al: Chemotherapy and cognitive impairment: Treatment options. Clin Pharmacol Ther. 2011;90:366-376

Jill Shelton, RN, BSN, is a clinical manager for Outpatient Neurosciences at Vanderbilt Medical Center.

Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
External Resources

MJH Associates
American Journal of Managed Care
Cure
MD Magazine
Pharmacy Times
Physicians' Education Resource
Specialty Pharmacy Times
TargetedOnc
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