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Post-Chemotherapy Cognitive Impairment

Instructor: Karin Gonzalez

Karin has taught middle and high school Health and has a master's degree in social work.

Cancer is not a cancer patient's only worry; sometimes negative effects from treatments such as chemotherapy can be a concern. Learn the definition, prevalence, causes, and treatment techniques of post-chemotherapy cognitive impairment in this lesson.

What Is Post-Chemotherapy Cognitive Impairment?

Mary, who has been diagnosed with stage 3 colon cancer, has endured a couple months of chemotherapy treatment sessions so far. Chemotherapy is the use of cytotoxic medicines and drugs as treatment against disease; the cytotoxic drugs used are designed to kill toxic cancer cells in the body. As a result of the treatment, she is now noticeably forgetful. For example, she had trouble recalling the names of her church friends, and even struggled with recalling her own date of birth and social security number when renewing her passport. Mary's forgetfulness and fogginess is troubling for herself and her family members. The symptoms that Mary has been showing are common signs of post-chemotherapy cognitive impairment. Post-chemotherapy cognitive impairment (PCCI) is a diminishment in mental sharpness that occurs as a result of treatment of cancer with chemotherapy.

A patient receives chemotherapy via IV (intravenous) therapy.
Nurse administers chemotherapy

Post-chemotherapy cognitive impairment can be characterized by marked forgetfulness, fogginess, difficulty multitasking, disorganization, slow information processing, memory lapses, and difficulty concentrating. For Mary, her forgetfulness and cognitive decline persisted for only a few months. Other cancer survivors are not as lucky; research studies have recorded that some individuals experience symptoms for up to 10 years after chemotherapy treatment.

Prevalence of Post-Chemotherapy Cognitive Impairment

The American Cancer Society estimated that there will be 1,658,210 new cancer diagnoses in 2016. Not all cancer patients need or receive chemotherapy; some cancer patients have surgery, receive radiation, nutritional treatments, etc. to treat their cancer instead.

Many cancer patients do receive chemotherapy, though. According to the Center for Disease Control, there are about 650,000 cancer patients that receive chemotherapy each year; about 36% of individuals who receive a cancer diagnosis get chemotherapy treatment in the United States.

The National Health and Nutrition Examination Survey wanted to determine just how extensive reports of cognitive decline were across the United States. The study results revealed that being a cancer survivor who had received chemotherapy increased the likelihood that a person would experience cognitive impairments by a whopping 40 percent!

Many research studies have been carried out to determine the prevalence of post-chemotherapy cognitive impairment. According to the literature on these studies, there is a large variance ranging from 16% to 75% of patients who received chemotherapy that reported significant cognitive decline.

Assessment of Post-Chemotherapy Cognitive Impairment

Mary visited her doctor, concerned about her cognitive decline. Her doctor gave her an evaluation that she could fill out herself, to test whether or not she was actually experiencing symptoms of post-chemotherapy cognitive impairment.

This evaluation is called the Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) scale. It is a self-report assessment for mental fogginess, deficits in attention and concentration, memory lapses, verbal incoherency, as well as deficits noticed by friends, colleagues, or family members. The FACT-Cog also assesses a change from previous functioning and the infringement of the cognitive impairment on the patient's quality of life.

Causes of Post-Chemotherapy Cognitive Impairment

Mary has a lot of questions as to why she now has cognitive decline after chemotherapy. The truth is the cause of post-chemotherapy cognitive impairment is unknown. With this being said, there are several theories as to why chemotherapy causes cognitive decline. Mary's doctor reviews them with her.

Chemotherapy can cause:

  1. Changes in the brain's white and grey matter - This can cause deficits with memory.
  2. Cellular Damage - A handful of some drugs used in chemotherapy can cross the blood-brain barrier (BBB) and cause neurotoxicity, which leads to cognitive impairment.
  3. Chemotherapy-induced anemia - When the blood count decreases, the resulting anemia can make a person feel tired due to loss of oxygen in the brain. Anemia can even cause visual memory issues.

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