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Chemo fog, chemo brainwhat do we know?

Lynne Brophy, RN, MSN, AOCN Barb Henry, APRN-BC, MSN Dr. Peter Sheng June 6, 2009 The Wellness Community Blue Ash

Definition of Chemo brain


phenomenon affecting perhaps 1/3 of patients receiving chemotherapy for cancer in peripheral locales such as the breast (Olin, 2001). Self reported cognitive impairment that affects: verbal and visual memory, attention, concentration, language, motor skills, multitasking and ability to organize information
Example: balancing the checkbook!

How does chemo brain affect the person?


of concentration and ability to listen carefully in social/work situations Difficulty delaying responses when appropriate Decreased ability to learn important information Ability adhere to complex treatment regimens decreases (Cimprich, 1995)

Cimprich says

dealing with a life threatening situation, such as cancer, lowered capacity to direct attention could lead to a decreasing sense of personal effectiveness and ability to cope with a situation. (Cimprich, 1995)

What do we know about chemo brain?


little few studies to date, none of which were done in a proper fashion to make conclusions
Unable to judge whether this problem is attributed to just chemotherapy


studies point out that chemo brain starts before treatment begins and may resolve in some patients within four years (Cimprich, 2001)

Possible causes

Illness (Diabetes, Multiple Sclerosis, Congestive Heart Failure, Chronic Lung Disease, cancer) Biochemical changes from the cancer Stress, anxiety Hormonal changes menopause (is it more common in women?) Attentional fatigue Depression (Raffa, 2006)

Possible causes
Anemia Electrolyte

imbalances (ex. Low potassium) Medications Thyroid dysfunction Infection Hepatic and renal dysfunction Brain Metastases (Coyne, 2004)

More possible causes


to opioid

Therapy Aging (although kids report chemo brain)

Further studies are needed


need randomized, controlled trials with long term follow-up and probably brain imaging to determine what the cause of chemo brain really is We have no base of evidence to support interventions but there are things you can try safely to see if they help..

Clearing the fog


for economy of information Reduce of avoid time pressure Focus on priorities, break large tasks into smaller goals Create structure in daily activities (Cimprich, 2006)

Clearing the chemo fog



use of devices and methods which assist

Lists, notes, avoidance of distractions (Tannock, 2004)


attention and clear thinking through

Adequate sleep Avoidance of alcohol Healthy eating Relaxation perhaps with nature component (Love, 2009; Cimprich, 1995)

Clearing the chemo fog


help for depression, anxiety, stress integrative



Which came firstchemo brain or depression/anxiety?!..


brain can lead to depression and anxiety because a person is not themselves approach-lower your expectations/pressure on yourself, its ok to admit to Chemo brain, most people know what it is, can relate depression/anxiety symptoms are dominant every day all day long x 2 weeks psychotropic medications (and counseling) may help



Brain chemistry changes take place at the nerve cell synapse with depression, anxiety, and chronic illness. Counseling and medications can help restore brain chemistry and improve mental health but may not always help chemo brain.

Stephen Stahl, 2008

Sertraline/Zoloft 50 mg Venlafaxine/EffexorXR 37.5 mg Escitalopram/Lexapro 20 mg Citalopram/Celexa 20 mg Buproprion/Wellbutrin XL 300 mg

Paroxetine/Paxil 20 mg

Paroxetine/Paxil CR 12.5 mg

Desvenlafaxine/Pristiq XL 50 mg Duloxetine/Cymbalta 60 mg

Mirtazepine/Remeron 15 mg

Doxepin/Sinequan 25 mg

Amitriptylene/Elavil 10 mg

Trazodone/Desyryl 50 mg Norpramin/Desipramine 10 mg

Nortriptylene/Pamelor 150 mg

Fluoxetine/Prozac 10 mg

Seligilene/Ensam Patch 6 mg/24hrs Nardil/Phenelzine 15 mg Parnate/Tranylcypromine 10 mg

Imipramine/TofranilPM 75 mg

http://www.epocratesonline.com 2009

Anti-Anxiety Agents

Lorazepam/Ativan 0.5 mg

Alprazolam/Xanax 0.5 mg

Alprazolam/XanaxCR 1 mg

Clonazepam/Klonopin 0.5 mg

Oxazepam/Serax 15 mg

Hydroxazine/Vistaril 25 mg

Diazepam/Valium 5 mg

Diazepam/Valium 10 mg

Chlordiazepoxide/Librium 5 mg

Chlorazepate/Tranxene 15 mg

Buspiron/Buspar 15 mg

Propranolol/Inderal 60 mg

http://www.epocratesonline.com 2009

Sleep Agents

Flurazepam/Dalmane 15 mg

Temazepam/Restoril 30 mg

Triazolam/Halcion 0.25 mg

Diphenhydramine/Benadryl 25 mg

Zalepion/Sonata 10 mg

Zolpidem/Ambien 10 mg

Zolpidem/Ambien CR 6.25 mg

Eszopiclone/Lunesta 3 mg

Ramelteon/Rozeram 8 mg

Estazolam/Prosom 2 mg

Chloral Hydrate 500 mg/5 cc

http://www.epocratesonline.com 2009

Antipsychotic Medications

Risperidone/Risperdal 4 mg

Risperdol Consta IM 50 mg

Olanzapin/Zyprexa 20 mg

Quetiapine/Seroquel 25 mg

Quetiapine/Seroquel XR 400 mg

Chlozapine/Chlozaril 100 mg

Aripiprazole/Abilify 2 m

Ziprasidone/Geodon 20 mg Paliperidone/Invega 9 mg

Prochlorperazine/Compazine 5 mg

Metochlorpramide/Reglan 5 mg Chlorpromazine/Thorazine 50 mg Thioridizine/Mellaril 50 mg Perphenazine/Trilafon 4 mg

Haloperidol/Haldol 10 mg

Loxipine/Loxitane 10 mg

Fluphenazine/Prolixin 5 mg

Fluphenazine/Prolixin D 25 mg/ml

Haloperidol/Haldol D 100 mg/ml

http://www.epocratesonline.com 2009

Mood Stabilizers & Other Miscellaneous Psychotropic Meds

Lithium Carbonate/Lithium 300 mg Divalproax/Depakote 500 mg Lamotrigine/Lamictal 200 mg Gabapentin/Neurontin 300 mg Carbamazepine/Tegretol 200 mg

Oxcarbazepine/Trileptal 150 mg Topiramate/Topamax 200 mg Quetiapine/Seroquel XR 400 mg Olanzapine/Zydis 20 mg

Ziprasidone/Geodon 80 mg

Catapress/Clonidine Patch 2 mg

Benztropine/Cogentin 2 mg

Trihexiphenidyl/Artane 2 mg

http://www.epocratesonline.com 2009

Other Psychotropic & Misc. Meds

Methylphenidate/Ritalin 5 mg

Methylphenidate/Concerta 54 mg/24 hrs

Amphetamine/Adderrall 10 mg

Atomoxetine/Strattera 60 mg

Lisdexamphetamine/Vyvanase 70 mg

Modafinil/Provigil 200 mg

Varenicline/Chantix 1 mg

Varenicline/Chantix 1 mg

Sildenafil/Viagra 100 mg

Vardenafil/Levitra 20 mg

Tadalafil/Cialis 20 mg

http://www.epocratesonline.com 2009

Another pill may not be the answer!

Psychotropic Symptom

medications can add to cognitive slowing and have other side effects relief may take 2 weeks or more, sometimes improvement is noticed sooner


you take psychotropic medicine do not discontinue rapidly/requires tapered doses meds can help for 6 months to a year until immediate crisis is resolved, sometimes it helps for a lifetime-like a vitamin


Mayo Clinic tips for chemo brain

Ginkgo. Supplements containing ginkgo leaves have shown some promise in treating age-related memory changes in older adults, but more study is needed. Ginkgo supplements are generally safe, but they can interfere with some common medications, including blood thinners. Talk to your doctor before beginning ginkgo supplements. Vitamin E. Vitamin E may be beneficial for brain cells, but more study is needed. Vitamin E supplements are generally safe when taken in recommended doses, but they can interfere with common medications, including blood thinners and chemotherapy drugs. It may be easier and safer to choose foods that are high in vitamin E, such as vegetable oils and eggs. Controlling other causes of memory problems Cancer and cancer treatment can lead to other conditions, such as anemia, depression, sleep problems and early menopause, which can contribute to memory problems. Controlling these other factors may make it easier to cope with these symptoms. Learning to adapt and cope with memory changes A psychotherapist can focus your treatment on helping you cope with chemo brain symptoms using cognitive rehabilitation and brain/memory exercises

Other healing therapies-Qui Gong, Tai Chi, Reiki, Cranio-sacral therapy, Message, Healing Touch, Relaxation, Guided Imagery, Support Groups, and others such as those Dr. Sheng will describe