Does it subside after treatment has finished ?
Unfortunately , it often takes a long time to improve , long after chemotherapy has finished . It may continue to improve for up to two years following chemotherapy before plateauing .
Some patients never return to the same level of function that they had prior to their diagnosis and treatment . This has an impact on family and social function , as well as employability . We have research showing that women who have chemotherapy for early stage breast cancer are less likely to return to paid employment and , if they do return , they work fewer hours . The lack of effective treatments is a major challenge .
Do all patients suffer from it ?
Not every patient has chemo brain and it presents along a spectrum , from very mild up to debilitatingly severe . Research suggests that during chemotherapy , up to 75 % of patients experience some sort of cognitive problems . Many of those will improve substantially after chemotherapy is finished if they have a course of chemo for early stage disease . On the other hand , patients with advanced or metastatic disease might remain on chemotherapy for a long time , so don ’ t have the opportunity for their chemo brain to subside .
Patients who were in high functioning roles seem to notice the most impact , both in terms of their ability to perform the work itself and their ability to juggle the demands of work and family / social commitments .
Why does exercise help with chemo brain ?
Exercise helps in so many ways to improve quality of life during and after chemotherapy , and , in fact , increases the likelihood of survival in many cancer types . As for chemo brain , it helps with physical and therefore mental stamina .
Loss of physical endurance , fitness and strength is also common with chemotherapy , and exercise reduces that loss . It helps create a better mood , reduces depression and anxiety , and aids sleep quality . All of these have an impact on cognition .
Exercise increases blood flow to the brain and minimises the microscopic blood vessel damage that can occur with chemotherapy . It also helps reverse the metabolic syndrome of high blood sugar / pre-diabetes and high cholesterol-related inflammation . We need to do more research into which of these components is the critical factor in the benefits of exercise , but it is likely to vary according to the individual patient .
What sort of exercise is best to help ?
In short , any sort of exercise ! To be more specific , it is best to get your heart rate up . International guidelines call for 150 minutes per week of moderate to vigorous intensity exercise for patients with cancer . While incidental exercise like walking to the shops is useful , it ’ s just not as beneficial as when you start to feel like
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you are working reasonably hard . That means breathing a bit faster , feeling the heart rate go up and breaking a sweat .
Cardiovascular exercise like walking , cycling , swimming ; mind body exercise such as yoga and tai chi ; and strength-based exercise such as resistance training are all good . Not every cancer patient will be able to participate at this level at all times , and it needs to be adapted according to ability during the chemo cycle as some days will require more rest . However , it will often be possible to do some exercise most days , especially with support from friends and family . A very valuable support is participating in an exercise physiology program tailored to cancer patients that is available at some cancer centres .
What other benefits does exercise have for people going through breast cancer treatment ?
Exercise has so many benefits . Regular exercise reduces mortality from both cancer and other causes . It lifts the mood , improves sleep and translates into better functioning from day to day . It helps with tolerance of cancer treatments , meaning that the treatments are more likely to be completed , with greater chance of those treatments being beneficial .
Breast cancer treatments can weaken the bones , causing osteoporosis . Exercise like running , hopping , jumping and skipping helps reduce bone loss . It also often gets you out in the sunshine which can assist the bone-building effect of vitamin D and , of course , provides the social benefits of doing something with a friend .
For further information about breast cancer research , please visit www . breastcancertrials . org . au .
Dr Nick Zdenkowski , BMed FRACP PhD Nick is a medical oncologist and a clinical researcher . He treats patients with a range of different types of cancer , and has a special interest in the care of patients with breast and gastro-intestinal cancer .
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