How to Manage Chemo Brain with Dr. Jorg Dietrich

Leigh Clark:    00:00    Hi, everyone. This is Podcast for Patients with the Aplastic Anemia Aplastic Anemia: (ay-PLASS-tik uh-NEE_mee-uh) A rare and serious condition in which the bone marrow fails to make enough blood cells - red blood cells, white blood cells, and platelets. The term aplastic is a Greek word meaning not to form. Anemia is a condition that happens when red blood cell count is low. Most… and MDS International Foundation. I'm Leigh Clark, Director of Patient Services. Our podcast series is brought to you thanks to the generous support of our patients, families, and caregivers like you, and our wonderful corporate sponsors. Thank you everyone for supporting the series.
    00:26    Today, we're talking about chemo brain with Dr. Jorg Dietrich, who is the Director of the Cancer and Neurotoxicity Clinic and Brain Repair Research Program at Mass General Hospital Cancer Center. Welcome, Dr. Dietrich.
Dr. Jorg Dietrich:    00:45    Thank you very much for having me.
Leigh Clark:    00:48    So, let's start out, what is chemo brain?
Dr. Jorg Dietrich:    00:52    Yes. Chemo brain is not a scientific or a medical term, but it, uh, has been historically understood as a syndrome that occurs in patients treated with usually high dose chemotherapy chemotherapy: (kee-moe-THER-uh-pee) The use of medicines that kill cells (cytotoxic agents). People with high-risk or intermediate-2 risk myelodysplastic syndrome (MDS) may be given chemotherapy to kill bone marrow cells that have an abnormal size, shape, or look. Chemotherapy hurts healthy cells along with… regimen for systemic cancer. And as a consequence patients describe and suffer from an altered brain function that usually involves their cognitive abilities. And, as I said, historically this has been, uh, described very frequently in patients treated for breast cancer, lung cancer, or even hematological malignancies. And over the years, it became clear that this spectrum of underlying conditions that are treated with chemotherapy options is, including a very wide range of cancers with different probabilities to develop this condition of chemo brain.
    01:56    I would also like to mention that studies have identified frequencies in which such syndromes can, uh, be present and evolve, and that ranges up to 70 to 80% of patients being affected. The good news, however, is that most patients develop only very mild symptoms. Often, these are reversible and, uh, patients return to their usual, uh, neurological function and cognitive abilities prior to treatment. And it will be important, uh, as we can discuss in this session today to rule out important other factors that could contribute or influence the manifestation of various symptoms.
Leigh Clark:    02:45    Thank you for that. And what are the signs and symptoms that a patient should be looking for if they feel they are suffering from chemo brain?
Dr. Jorg Dietrich:    02:56    The most commonly reported and described symptoms affect memory function. Patients typically would mention that their short-term memory is not as good and they tend to forget things that were just discussed, uh, on a given day or in a previous conversation, as a consequence, uh, often reduced attention, altered concentration on a specific task, and a heightened distractibility is described. And therefore, patients often then have difficulties with multitasking and a- altered executive function. That means certain tasks that are planned and are supposed to be executed, uh, cannot really be done in an efficient manner.
Leigh Clark:    03:46    Are there some things that a patient can do to help reduce the symptoms of chemo brain?
Dr. Jorg Dietrich:    03:53    Yes. Most critically I think the necessity to bring up these symptoms and their concerns to their medical provider, to their, primary care physician, or any other doctor of trust that they would like to run these symptoms by. The reason is that a comprehensive medical evaluation is necessary to identify other contributing factors to such symptoms, namely mood alterations or depression, sleeping difficulties, um, metabolic syndromes, or vitamin deficiencies. Patients with anemia anemia: (uh-NEE-mee-uh) A condition in which there is a shortage of red blood cells in the bloodstream. This causes a low red blood cell count. Symptoms of anemia are fatigue and tiredness. or altered thyroid function can have similar, symptoms that they report.
    04:41    And that often then leads, uh, after a comprehensive medical assessment, to a more dedicated cognitive assessment with a neuropsychologist. And the goal of such an assessment is to, uh, really better characterize the degree and pattern of cognitive disfunction and the domains of brain function that are mostly, uh, affected.
    05:06    If this is all done and, uh, everybody agrees that the patient indeed suffers from the consequences of prior treatment, then what patients can do most effectively, uh, and contributing to their recovery is regular physical exercise, that's number one. That has been proven and in many clinical trial clinical trial: A type of research study that tests how a drug, medical device, or treatment approach works in people. There are several types of clinical trials. Treatment trials test new treatment options. Diagnostic trials test new ways to diagnose a disease. Screening trials test the best way to detect a… , studies, and also in preclinical, uh, studies and investigations, to help, uh, brain function to recover, to form new networks in existing brain structures. And therefore, increase the overall brain function.
    05:48    Uh, second, working on a restorative sleep is considered key in any successful intervention. If the sleep is not optimal, then patients will continue to have daytime fatigue and altered cognitive function.
    06:05    Third, I think relaxation techniques or, uh, stress reducing interventions have been successfully employed. atients who are overweight or obese can work on a, a diet regimen and altered nutrition to reduce weight. And therefore, along with the increased physical activity, contribute to their recovery.
    06:30    And then lastly, I think from basic sciences we have learnt that engaging in, in new activities or learning a new skillset is often allowing the brain to open new channels for function, and, uh, considered in using the keyword of environmental enrichment, to help, uh, patients recover and basically return to their previous level of, of function.
    06:58    Znd then lastly I would mention that, besides these, tasks and interventions that patients can contribute to, that certain pharmacological interventions can be done, and that needs to be discussed with their physician.
Leigh Clark:    07:17    What is cognitive rehabilitation?
Dr. Jorg Dietrich:    07:21    Cognitive rehabilitation has a- an important role in this, uh, disorder or this syndrome. It is considered a, uh, systematic and functionally-oriented therapy that is based on a patient-specific cognitive deficit. It is offered as such in various settings. It can be, uh, done as an outpatient or in inpatient settings, in rehab centers, or even in nursing facilities. The goal really is to identify areas of brain function that are most affected and that can be supported and promoted through cognitive, uh, compensation strategies and cognitive training.
    08:03    So, this classically then involves, uh, computer-based training techniques to improve memory function. And there are also holistic approaches that, uh, involve the therapeutic intent in the patients' community so that you really try to apply a real world setting, uh, where such deficits are most pronounced, to help, uh, patients compensate and, uh, find ways to practice and, uh, teach certain skills where they have the most difficulties with.
Leigh Clark:    08:46    Is there research being conducted currently to better understand chemo brain and to look for treatments?
Dr. Jorg Dietrich:    08:55    Yes, absolutely. So, research plays a major role in understanding this condition, uh, especially over the last 10, 15 years, major breakthroughs have been made in this condition; namely, it has been identified which areas of the brain and which, uh, cell types of, uh, brain and neuro networks are mostly affected, uh, in the context of exposure to chemotherapy. We now know that the insulating fibers and, uh, cell types called oligodendrocytes that ensheath nerve endings and axons are very vulnerable to the effects of systemic chemotherapy.
    09:41    But besides that, diverse mechanisms have been identified, such as chronic inflammatory responses in the brain that really interfere with normal brain function. And, one has also understood i- increasingly the genetic underpinnings of such syndromes to understand why certain individuals are more affected than others and not everybody exactly in the same way. So, research also has, besides identifying causes of chemo brain, helped to, uh, make inroads to the treatment options that might arise or being developed. Uh, there are pharmacological interventions that are, uh, designed to promote myelin health, so, uh, the health of these oligodendrocytes that I mentioned, to increase brain plasticity, and to reduce perhaps cancer therapy related brain aging, uh, mechanisms. The goal really is to limit the toxicity and impact of cancer and cancer therapy on brain structure. And there are a number of clinical trials clinical trials: Clinical research is at the heart of all medical advances, identifying new ways to prevent, detect or treat disease. If you have a bone marrow failure disease, you may want to consider taking part in a clinical trial, also called a research study. Understanding Clinical Trials Clinical… being conducted currently to test for normal pharmacological, uh, agents to be employed.
    10:57    That all said, while the research activity is high in this field and increasing, uh, we have really not yet established a standard of care approach that would allow us to really offer certain treatment interventions, pharmacological interventions to any patient with such syndrome. But I am personally hopeful that in coming years, uh, this will change with all the current research activity I'm seeing.
Leigh Clark:    11:28    Thank you so much, Dr. Dietrich for sharing your time and your expertise with all of us today. If you'd like to find out more about chemo brain and other information about bone marrow failure bone marrow failure: A condition that occurs when the bone marrow stops making enough healthy blood cells. The most common of these rare diseases are aplastic anemia, myelodysplastic syndromes (MDS) and paroxysmal nocturnal hemoglobinuria (PNH). Bone marrow failure can be acquired (begin any time in life) or can be… diseases, you can find this information on our website, which is aamds.org. You can also contact us at our helpline at (800) 747-2820. Or, follow us on Facebook, Instagram, and Twitter. Thank you so much for joining us today. Have a good day.