Analysis: Scientists are investigating how cancer causes changes in people’s bodies that may impair their ability to think clearly
Over 40,000 people in Ireland are diagnosed with cancer each year. Navigating the first few weeks and months after an initial diagnosis is challenging, as people try to understand the disease, its implications as well as the various treatment options.
After diagnosis, each individual must digest a mountain of information about the disease and have the mental clarity to make important decisions and implement life changes. For these reasons, it would be next to impossible for anyone to navigate the difficult journey of cancer treatment without being in good cognitive health.
Living with cancer can place a burden on the person's physical health, but also their mental health and wellbeing. The mental burden of having cancer is, for some people, made more difficult as it also requires the person with cancer to remember information, focus on tasks and decisions and generally attend to the complex situation that they now find themselves in. When people experience these difficulties, researchers often refer to it as brain fog, cognitive dysfunction or 'chemobrain’.
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From RTÉ Radio 1's Morning Ireland, Cancer is the single biggest killer in Ireland with almost 10,000 deaths a year
Chemotherapy can impact on people’s brain functions while they are undergoing cancer treatment, but researchers now believe that there are other more complex factors at play when people report issues with attention, memory and focus before or after treatment, because cancer itself can impact cognitive function in many ways. Researchers are investigating these factors to try and better understand why some people with cancer can experience cognitive problems.
Researchers believe that one potential factor involved in cognitive function in cancer patients is their psychological well-being. The experience of people living with aggressive cancers and having to undertake invasive chemotherapies is challenging enough in the absence of feeling anxiety and depression. It is little wonder, when these difficulties are present, combined with the challenges of diagnosis and treatment, that some are vulnerable to impaired decision making.
Scientists are investigating how cancer causes changes in people’s bodies that may impair their ability to think clearly. The goal is to identify factors, other than treatment (chemotherapy) - which are causing cognitive problems in some people and identify people who may be at risk from these effects more quickly.
There is a huge amount of information online and in the research record about how people can stay fit and active, eat well, and support their mental health during and after their cancer treatment. We know that staying fit and active, eating well and maintaining mental health are important during and after cancer treatment, but there is far less information about what people with cancer can do to protect their cognitive health, while undergoing treatment, to improve their overall well-being.
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From Louise McSharry on 2FM, Neuroscientist and health psychologist Dr Sabina Brennan explains brain fog
It's often the case that cognitive issues will go unnoticed, even by the people with cancer themselves. In many situations, people and caregivers will focus solely on a person’s immediate physical recovery. These people find that when they make the transition back to work or school that while they are feeling physically well, they are struggling to carry out their study or work to the same standard as they did before their cancer treatment, as a result of having trouble with their focus and attention.
Researchers – by increasing research and awareness of this issue - are opening the door for people who are struggling in this way to have conversations about the cognitive difficulties they are experiencing with their family, friends and healthcare specialists. After all, the ability to think clearly and feel confident in decision making is an essential part of a high quality of life, as is feeling in control through a cancer diagnosis, treatment and recovery process.
Rehabilitation
The goal of rehabilitation is to help people recover from their illness and restore overall functioning. We know that exercise, nutrition, support groups and one-to-one therapy can really help people with cancer. However, it may be difficult for a person with cancer to engage in a rehabilitation programme if they can’t think clearly or pay attention, while struggling to process and remember information.
Rehabilitation strategies can be tailored to help address cognitive problems in people with cancer. Research is underway in Ireland to understand the role of rehabilitation programmes like exercise and nutrition before and after cancer treatment to see how this may affect people’s ability to retain information, think clearly and focus.
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From RTÉ Radio 1's Today with Claire Byrne, TCD Professor and psychologist Anne-Marie O'Dwyer on coping with a cancer diagnosis
Cognitive rehabilitation is a more recent area that aims to help people struggling with cognitive issues after cancer. In the future, we believe that cognitive health should be offered to patients alongside physical and mental aspects of rehabilitation by using educational programmes, therapy and brain training techniques.
The use of cognitive rehabilitation has, to date, been mainly used for people recovering from traumatic brain injury or stroke. We are learning, through research, whether similar principles can be applied to people with cancer in order to help them learning how to cope with day-to-day issues and restore or improve their cognitive functions.
A ‘one size fits all’ approach may not address all the issues that need to be faced by people experiencing ‘chemobrain’. We can begin to tackle it, however, by identifying how and why cognitive issues first appear in people with cancer. Following on from that, researchers are aiming to create rehabilitation options that will need the needs of individual’s cognitive issues using tailored rehabilitation techniques.
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We must continue to investigate how cognitive issues arise in different cancer types and develop different cancer treatments in order to better identify and help people who could benefit the most. The time has come to address the cognitive issues faced by some people with cancer and to provide proper services and screening for them.
Once researchers can better understand the complex interaction between cognitive health, cancer treatment, diagnosis, biology and emotional well-being they can begin to understand how to help people experiencing these issues.
One potential area of treatment to explore is the use of classic rehabilitation techniques like exercise and nutrition support, not only after, but also before treatment. This is done to help protect against treatment-related stress, known as prehabilitation. We believe that newer approaches targeting cognitive health specially could also be beneficial. Until cognitive health is firmly embedded in our conversations about cancer, some people with cancer will continue to feel isolated, and destined to struggle in silence.
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The views expressed here are those of the author and do not represent or reflect the views of RTÉ
