Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
LETTER TO THE EDITOR
Year : 2012  |  Volume : 8  |  Issue : 1  |  Page : 162-163

The neurobiological basis of anti-cancer therapy induced cognitive dysfunction and the promising pharmacological modalities against the same


Department of Radiation Therapy and Oncology, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, India

Date of Web Publication19-Apr-2012

Correspondence Address:
Swaroop Revannasiddaiah
Department of Radiation Therapy and Oncology, Regional Cancer Centre, IGMC, Shimla, Himachal Pradesh - 171 001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.95207

Rights and Permissions

How to cite this article:
Revannasiddaiah S, Gupta M, Seam R, Gupta M. The neurobiological basis of anti-cancer therapy induced cognitive dysfunction and the promising pharmacological modalities against the same. J Can Res Ther 2012;8:162-3

How to cite this URL:
Revannasiddaiah S, Gupta M, Seam R, Gupta M. The neurobiological basis of anti-cancer therapy induced cognitive dysfunction and the promising pharmacological modalities against the same. J Can Res Ther [serial online] 2012 [cited 2019 Sep 21];8:162-3. Available from: http://www.cancerjournal.net/text.asp?2012/8/1/162/95207

Sir,

We thank and commend the author of the article titled 'Psychostimulants for chemotherapy induced cognitive changes in cancer' [1] (July-September 2011 issue of this journal) for having brought a much deserved quantum of notice for a ubiquitous, but often ignored issue.

Cognitive changes after therapy for breast cancer can arise from the neurological toxicities of therapy as well as of a result of psychological stresses (of cancer diagnosis and the uncertainties of outcomes). It would be improper to blame all of the symptoms of therapy-induced cognitive impairment upon chemotherapy alone. Therapy in breast cancer can include a combination of surgery, chemotherapy, radiotherapy and hormonal manipulation. Surgery is undeniably associated with psychological stress, physical trauma and body image alteration issues. Hormonal manipulation can induce quasi-menopausal symptoms (and the associated cognitive changes). Radiotherapy is a well-known factor exacerbating the entity called 'cancer-related-fatigue', which includes neurocognitive fatigue within its domain. [2]

Cytotoxic therapies (chemotherapy and radiotherapy) cause an upheaval in the levels of cytokines such as TNF-α, IL-1, and IL-6. These very cytokines, which are pro-inflammatory in the periphery, do behave as inhibitory neurotransmitters within the central nervous system. [2],[3]

This recent emergence of evidence in favor of a neurochemical basis for 'chemo-brain' indicates that psychological measures such as counselling and cognitive behavioural therapy may not be effective in countering the neurobiological changes.

There have been randomized controlled trials which have been conducted with an intent to evaluate the pharmacological interventions in countering the development of- and in the treatment of cancer-therapy related neurological changes such as 'cancer-related-fatigue' and 'chemo-brain'. Agents tried include anti-inflammatory cyclooxygenase inhibitors which intend to curb the rise in inflammatory cytokines, psycho-stimulants such as methylphenidate which act as a stimulant for the 'dampened' nervous system and anti-depressants such as paroxetine. [4] All these agents have been successful to various extents and unequivocally better than non-pharmacological measures (such as yoga, meditation, counselling and acupuncture).

Two very recent breast-cancer specific trials have proven the superiority of pharmacological intervention for the prevention of chemotherapy-induced fatigue and cognitive changes. These two trials [5],[6] utilized modafinil, a new eugeronic (wake-promoting) drug which was initially approved for use in narcolepsy and excessive daytime sleepiness. This drug has also been used off-label to treat fatigue of neurological origin in multiple-sclerosis, chronic-fatigue syndrome etc.

Until final conclusive results of drug-intervention trials such as the NCT00917748 (MOTIF trial) and NCT01440621 (ModCRF trial) are available, we must ensure a compassionate and sympathetic approach to every patient complaining of these rather vague, ill-defined effects on cognition and affect. It indeed would be a travesty to discard and disregard a patient's complaint, without attempting to understand that, let alone relieve it.

 
 > References Top

1.Dutta V. Psychostimulants for chemotherapy induced cognitive changes in cancer. J Cancer Res Ther 2011;7:264-9.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Stone P, Richards M, A'Hern R, Hardy J. Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy. J Pain Symptom Manage 2001;22:1007-15.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Loftis JM, Huckans M, Morasco BJ. Neuroimmune mechanisms of cytokine-induced depression: Current theories and novel treatment strategies. Neurobiol Dis 2010;37:519-33.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Breitbart W, Alici Y. Psychostimulants for cancer-related fatigue. J Natl Compr Canc Netw 2010;8:933-42.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Kohli S, Fisher SG, Tra Y, Adams MJ, Mapstone ME, Wesnes KA, et al. The effect of modafinil on cognitive function in breast cancer survivors. Cancer 2009;115:2605-16.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Jean-Pierre P, Morrow GR, Roscoe JA, Heckler C, Mohile S, Janelsins M, et al. A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: A University of Rochester Cancer Center Community Clinical Oncology Program Research base study. Cancer 2010;116:3513-20.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  



This article has been cited by
1 Psychostimulants for chemotherapy induced cognitive changes in cancer, Ockhamęs razor, anyone
Dutta, V.
Journal of Cancer Research and Therapeutics. 2012; 8(2): 326-329
[Pubmed]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
>References

 Article Access Statistics
    Viewed1505    
    Printed69    
    Emailed0    
    PDF Downloaded185    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]