Mesothelioma and the Brain

Malignant mesothelioma cancer rarely spreads to the brain, but chemotherapy that is most commonly used to treat the disease often causes substantial cognitive impairment.

Mesothelioma patients call it “chemo brain.”

Malignant mesothelioma is a rare and aggressive cancer typically caused by occupational exposure to asbestos.

There is no definitive cure, but specialty centers have used the latest therapeutic advances to develop a curative approach to treatment, which often begins with chemotherapy.

And while chemotherapy alone has shown only limited effectiveness in containing the disease for very long, it can have a definitive and often lasting effect on the brain.

Recent studies have shown that chemo brain is a real problem for people dealing with a variety of cancers, including mesothelioma, although it often is brushed aside as a not serious side effect.

Doctors Don’t Talk Much About Chemo Brain

Chemotherapy often comes with emotionally draining and physically exhausting side effects including hair loss, nausea and vomiting, diarrhea and mouth sores.

Often overlooked symptoms are fogginess and forgetfulness.

“Those are the side effects the doctors often don’t warn you about,” said 14-year mesothelioma survivor Michelle Marshall from Florida. “I used to have a great memory, but now I can’t remember things. I can get lost driving out of my neighborhood. I can’t even imagine trying to multitask again.”

Marshall didn’t need a medical study to tell her the chemotherapy treatments she received many years before scrambled her ability to remember things.

But she has several studies now.

Researchers at the Moffitt Cancer Center in Tampa analyzed 17 previous studies that included more than 800 breast cancer patients and determined that chemotherapy affected both verbal and visuospatial abilities, which includes the ability to judge distance, dimension, and space.

“Earlier studies had reported conflicting evidence on the severity of cognitive effects,” said Dr. Heather S.L. Jim, lead author of the study, which was published in the Journal of Clinical Oncology. “But it [chemo brain] really does exist. And there is no reason to think it’s exclusive to breast cancer patients.”

Chemo Brain Can Last Indefinitely

While many cancer patients believe the fogginess that accompanies chemotherapy often fades after six months to a year, for some the effects can linger indefinitely.

Data suggests chemotherapy does cross the blood brain barrier and is associated with shrinking some areas of the brain.

According to the multi-study analysis at Moffitt, individuals without cancer and without any chemotherapy treatments did considerably better than cancer patients, on tests of verbal ability and visuospatial ability.

“This often is overlooked, underreported,” Jim said. “For a lot of oncologists, it’s not always on their radar. Their focus is keeping patients alive and preventing recurrence.”

Cancer survivors often are baffled by the cognitive effects of chemotherapy, and even joke about forgetting things.

But studies show it is no joking matter.

Symptoms of Chemo Brain

The American Cancer Society now lists symptoms of chemo brain, including:

• Trouble answering the phone and cooking at the same time.
• Trouble remembering common words, making a patient unable to finish a sentence.

• Taking longer than normal to finish simple tasks.
• Trouble remembering details a patient previously knew well.
• Memory lapses that cause patients to forget recent events.

Most studies of chemo brain do not include baseline comparisons (done before chemotherapy), making them difficult to interpret. Methods of measurement also have varied widely from study to study.

The good news is help is on the way. A study at the University of Indiana involving breast cancer patients who underwent chemotherapy benefited from two types of therapy — speed processing and memory training — designed to help cognitive impairment.

Although the study was done only with breast cancer patients, researchers believe it would work for other types of cancer as well to lift the mental slowness.

“There still is much work to be done, but this is an exciting start,” said Dr. Diane Von Ah, lead researcher at the Simon Cancer Center at Indiana University. “It’s time we had something like this to offer patients.”

The speed of processing training put participants through a series of progressively more difficult informational tasks while utilizing a computer based program.

Mesothelioma and the Brain: Strategies That Help Combat the Problem

The memory training taught strategies for remembering sequences, text material, and word lists.

The Indiana study included a randomized trial that compared results of the training against a wait-list control group that received no training. All participants underwent chemotherapy.

“We saw positive results in both programs,” Von Ah said. “This was a small sample, but we saw some large effects.”

Cognitive assessments also were done before any of the training began to provide a baseline on each of the participants, and most everyone showed improvement.

Beyond the improvements, Von Ah said the assessments also showed a significant increase in quality of life after training had completed.

Fatigue, anxiety, distress and mood disturbance appeared to improve.

Another study published recently in the Journal of Clinical Oncology surveyed almost 600 women across the country who underwent chemotherapy treatment for breast cancer, and almost half reported a significant decline in cognitive abilities a month after treatment ended.

Mesothelioma and the Brain: Some People Are More Vulnerable

Problems included forgetting names of people they knew, forgetting how to find previously familiar places, and making mistakes writing down simple sentences.

Researchers struggled to explain a direct cause-and-effect relationship between chemotherapy and chemo brain but said certain people seemed more vulnerable to the problem.

“The bottom line is, this is a real problem,” said Dr. Patricia Ganz, director of cancer prevention and control research at the University of California’s Comprehensive Cancer Center. “We need to acknowledge it is one of the difficulties of treatment.”

Mesothelioma and the Brain: Mesothelioma Tumors Rarely Reach the Brain

Except for a few cases, mesothelioma tumors usually are never found in the brain, the bones or the adrenal glands.

Mesothelioma often starts in the thin membrane surrounding the lungs, eventually moving to a lung and other surrounding organs, along with the chest wall.

It can metastasize to the lymph nodes, the opposite lung, the liver, adrenal glands, and kidneys. Because it is typically not diagnosed in the early stages, mesothelioma treatment usually consists of with a palliative approach that includes only chemotherapy.

Less than a third of the patients qualify for a multidisciplinary mesothelioma treatment approach that includes surgery, radiation, and chemotherapy.

In addition to the cognitive impairment caused by chemotherapy, mesothelioma can also reduce the amount of oxygen that reaches the brain, resulting in Mild Cognitive Impairment (MCI). In the later stages of the disease, the effects are even more prominent.

Cancer survivors often don’t even talk to their oncologists about chemo brain, preferring to deal with it quietly and hoping it fades away.

Sometimes it does.

“Some people just breeze through it, and never have a problem again,” Jim said. “Sometimes patients will try and go back to work and are just not able to function properly. It can be debilitating cognitively.”

CogniFit offers cognitive assessments and cognitive stimulation programs to help patients stay aware of cognitive impairment and reduce the effects of chemo brain.

The Mesothelioma Center at Asbestos.com also offers advice to help patients with asbestos-related diseases find care and support. This includes mesothelioma, lung cancer, and asbestosis.

Tim Povtak is a writer at The Mesothelioma Center and Asbestos.com.