New Biomarker Discovered for “Chemobrain”

A new discovery may help cancer patients in chemotherapy with cognitive issues.

Posted May 07, 2019

GJD/Pixabay
Source: GJD/Pixabay

Cancer survivors and their caretakers know firsthand how devastating, traumatic, stressful, anxiety-ridden, and overwhelming it can be. Cancer is a group of over 100 diseases characterized by abnormal cell growth. Chemotherapy is a common treatment for cancer patients where powerful medication is administered in an effort to keep cancer cells from proliferating and spreading. An estimated 650,000 Americans with cancer undergo outpatient chemotherapy according to the Centers for Disease Control and Prevention (CDC). Cancer causes enormous physical, emotional, and psychological challenges for both the cancer patient and their families—any way to preempt unwanted chemotherapy side effects could help with the burden and suffering. Recently a team of researchers at the National University of Singapore (NUS) discovered new biomarkers for “chemobrain”—brain dysfunction resulting from chemotherapy that impacts cognition, concentration and memory.

Physicians may decide to use chemotherapy in combination with other forms of cancer treatments such as radiation, surgery, hormone therapy, targeted therapy, and even immunotherapy. The cancer patient undergoing chemotherapy may experience a wide array of unpleasant side effects in addition to chemobrain, such as nausea, pain, appetite loss, hair loss, fatigue, sores, diarrhea, cardiac issues, blood disorders, constipation, nervous system issues, and fertility issues.

During cancer treatment, up to 75 percent of patients experience chemobrain while undergoing treatment, and 35 percent have lingering cognitive dysfunction months after treatments has stopped according to the American Society of Clinical Oncology (ASCO).

Symptoms of chemobrain may include behavior and emotional changes, mood swings, inappropriate social behavior, disorientation, severe confusion, mental fog, comprehension issues, inability to multitask, slower thinking, reasoning and judgment issues, spatial disorientation, inability to focus, concentration issues, organizational issues, impaired math and language skills, and memory loss.

The researchers at the National University of Singapore published their biomarker discovery on March 20, 2019 in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, the peer-reviewed official journal of the American College of Clinical Pharmacy. Biomarkers are molecules found in the body (tissue, fluids or blood), that marks a disease, condition, or process (either abnormal or normal).

The team studied 81 patients with breast cancer, ranging from stage I up to stage III, with no prior radiation or chemotherapy treatment. The scheduled course of treatment for the patients was anthracycline‐based or taxane‐based chemotherapy.

The patients completed several self-perceived and objective cognitive function tests, along with having their blood plasma drawn for analysis. The Functional Assessment of Cancer Therapy–Cognitive Function (FACT‐Cog) Version 3 was used to evaluate the patients’ self-perceived quality of life within the past seven days. The patients’ self-reported their anxiety symptoms using the Beck Anxiety Inventory (BAI) assessment. To determine levels of fatigue, the self‐administered Brief Fatigue Inventory (BFI) was used. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30) was taken by the patients’ to self-report health-related quality of life. The EORTC symptom scale was used to assess insomnia. To measure the cognitive function objectively, patients’ took a computerized neuropsychological test called Headminder to evaluate memory, attention, response time, and processing speed.

According to the research report, “Dehydroepiandrosterone (DHEA) and its sulfated form (DHEAS)—jointly referred as DHEA(S)—are neurosteroids that serve important functions that help to regulate brain development, function, and behavior. DHEA(S) are purported to exert a cognitive‐preserving effect through their neuroprotective, antioxidant, anti-inflammatory, and antiglucocorticoid actions.”

The team wrote that prechemotherapy DHEA(S) levels “were found to be associated with impairment in the self‐perceived cognitive domains of verbal fluency,” and “mental acuity.”

“Our findings suggest that patients with higher prechemotherapy DHEAS levels had lower odds of developing self‐perceived cognitive impairment,” wrote the researchers.

The team suggests that DHEA(S) supplementation may be a pharmacologic intervention for cancer‐related cognitive impairment, and plans to conduct additional research studies. This discovery may potentially lead to novel therapeutic interventions to alleviate not only chemobrain, but also other chemotherapy complications—offering a glimmer of hope to cancer patients in the future.

Copyright © 2019 Cami Rosso All rights reserved.

References

Toh, Yi Long, Shariq Mujtaba, Juliana, Bansal, Sumit, Yeo, Angie, Shwe, Maung, Jiang Lau, Aik, Chan, Alexandre. “Prechemotherapy Levels of Plasma Dehydroepiandrosterone and Its Sulfated Form as Predictors of Cancer‐Related Cognitive Impairment in Patients with Breast Cancer Receiving Chemotherapy.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. March 20, 2019.

American Society of Clinical Oncology (ASCO). “What is Cancer.” Retrieved 5-7-2019 from https://www.cancer.net/navigating-cancer-care/cancer-basics/what-cancer

Centers for Disease Control and Prevention.” Preventing Infections in Cancer Patients.” Retrieved 5-7-2019 from https://www.cdc.gov/cancer/preventinfections/providers.htm

National Cancer Institute. “NCI Dictionary of Cancer Terms.” Retrieved 5-7-2019 from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/biomarker

American Society of Clinical Oncology (ASCO). “Side Effects of Chemotherapy.” Retrieved 5-7-2019 from https://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/side-effects-chemotherapy

American Society of Clinical Oncology (ASCO). “Attention, Thinking, or Memory Problems.” Retrieved 5-7-2019 from https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/attention-thinking-or-memory-problems