Is there quantitative data on patient complaints of cognitive impairment?
Yes. In breast cancer patients, the published data demonstrate that 21% to 90% of patients exhibit a subjective cognitive complaint (Schilder et al., 2012). In other words, they feel a decline in their cognitive performance. These subjective symptoms are not always related to brain functional abnormalities (results of cognitive neuropsychological tests). Sometimes they are related to anxiety, depression or fatigue.
What are the molecules your studies established an effect on cognition?
Our studies were primarily conducted with chemotherapies. For example, some research have demonstrated the impact of Fluorouracil and Methotrexate (these molecules cross the Blood-Brain Barrier) on cognitive function . Very recently, the impact on cognitive function was established for targeted therapies (angiogenesis inhibitors) as well.
Today, what are you certain concerning cancer and memory or attention deficits?
First, patients really complain about memory and attention deficits. However, this complaint is not always related to cognitive testss. In patients with breast cancer, 15% to 25% claim having decreased cognitive performances after undergoing chemotherapy. Certain specific patient groups, such as elderly, have a much higher risk of cognitive impairment.
Generally, cognitive disorders are transient and moderate, and they decrease or even disappear about 1 year after the end of the treatment.
Why using an animal model? Is it reliable?
The onset of cognitive impairment in a cancer patient is probably multifactorial, and may involve the cancer treatment, the medications used to counteract the adverse effects of these therapies, infection, anaemia, and metabolic changes caused by these treatments or the cancer itself. It may also involve the cancer patient’s psychological state, including stress, depression and/or anxiety.
The purpose of animal models is to better understand the direct impact of the molecules administered in the absence of cancer and to elucidate the effects on the central nervous system. It is possible to search for the type of risk factors, such as age or genetic markers, and to initiate assessement of the benefit of neuroprotective strategies. Indeed, some behavioural tests have been developed in animals and can be used to model certain disturbances observed in human patients. Biological brain testing helps better describe the mechanisms of the tested molecules.
What successes can be reported by the CNO in cancer and impaired cognition?
The scientific community is now well aware of this altered cognition. Subsequently, this problem was identified in the French government’s 2014-2019 Cancer Plan (the third edition).
We demonstrated that the decline in cognitive performance in elderly patients (aged 65 and over) is stronger than in younger women being treated for breast cancer.
We were also the first to observe that angiogenesis inhibitors could cause cognitive impairment in patients.
More recently, we have shown, for the first time in France, that cognitive stimulation (with neuropsychologist supervision) could reduce the cognitive complaints of patients, based on a large study (Cog-Reduc).
What specific services do you propose to Big Pharma?
- Evaluation of cognitive impairment in patients during clinical trials, with the possibility to conduct studies dedicated to elderly subjects,
- Design and implementation of clinical studies that focus on cognitive impairment in the context of of various treatments,
- Examination of difficulties encountered with oral treatments.
- Evaluation of specific cognitive functions disabled by cancer and cancer treatments using Adapted and standardised cognitive tests,
- Examination of the short – and long-term effects of treatments on cognition,
- Evaluation of the cognitive dysfunction perceived by patients and the impact on quality of life,
- Identification of possible links between perceived impairment and objective cognitive scores,
- Consideration of patient psychological status (anxiety, depression, fatigue…) to specifically grasp the impact of cancer and cancer treatments on cognition,
- Study of the influence of cognitive reserve and metacognition on the incidence of cognitive impairment,
- Cognitive rehabilitation as cognitive treatment,
- Study of anatomical brain modifications following cancer and cancer treatments (techniques:VBM and DTI),
- Study of functional brain alteration by using protocols of brain imaging: fMRI, PET (Positron Emission Tomography), which are in development,
- Comparing anatomical and functional brain modifications with the results of cognitive behavioural test batteries.
- Detection of biomarkers associated with cognitive deficits in animal models and in patients In connection with clinical and neuropsychological studies,
- Evaluation of the biological parameters that may influence the onset of cognitive impairment,
- Assessment of neurobiological parameters in cancer and non-cancer animal models to better understand the pathophysiology of the neurological changes observed in cancer patients. Focus on new behavioural study protocols in animals to better understand the mechanisms induced by new targeted therapies.
- Support in and/or writing of the statistical methodology dedicating to study protocols according the approved study design,
- Assistance in submitting projects to calls for proposals,
- Support in and/or writing of statistical analysis plan,
- Statistical analysis and result interpretations.
What advice would you give to patients with cognitive difficulties?
First of all, you should talk about it to your physician, who will first investigate other possible causes of theses difficulties (such as fatigue, anxiety, depression etc.) and suggest solutions to manage them.
Then, if these difficulties are still bothersome, one solution could be (upon your physician advice) to seek for a full cognitive assessment with a qualified neuropsychologist, within a “memory consultation” or in a memory center. The neuropsychologist will conduct a battery of neuropsychological testing, in order to diagnose objective cognitive impairment, and to identify precisely which cognitive domains are altered. According to the results of the tests, the neuropsychologist will then be able to suggest management solutions, adapted to your situation, to help you with daily tasks (cognitive training ; memory workshop alone or in a group ; physical activity practice etc.). In the absence of a nearby memory consultation, an alternative could be the Aloïs association, well aware of the chemobrain problem. Documentation about Aloïs is available here : website, flyer, flyer for general practitioners, flyer for specialist doctors.
If these solutions are not enough to relieve your discomfort, you could also contact (again, with your doctor’s approval) the OncoNeuroTox network, dedicated to the management of neurological side effects of cancer treatments (see the OncoNeuroTox flyer).
In any case, you should follow your doctors’ advice, as they can provide you solutions that are specifically adapted to your own needs.
When cancer impacts memory
By the Allodocteurs.fr 17/02/2011 editorial board.L
“Chemofog” is a condition experienced by many patients treated with chemotherapy. It is a kind of brain fog which prevents mental concentration and can be very disabling. Cancer-related side effects such as fatigue and memory disorders are now better taken into account by doctors. (Video duration around 5 min.)
Forget the cancer, not the rest ! When cancer and its treatments fill your thoughts with fog
Patients treated for cancer may present cognitive disorders such as confusion, visual and spatial memory alterations, mental flexibility impairment, or psychomotor slowing. These disorders are often described in the literature as “chemo fog” in reference to London’s fog. WHATCH THE VIDEO