Tuesday, February 28, 2012

Cognitive Effects of CMF May Last 20 Years

In a study reported yesterday in the Journal of Clinical Oncology, researchers found that breast cancer patients who received the chemotherapy regimen CMF between 1976 and 1995, scored significantly worse on tests of word recall, information processing speed, and psychomotor speed (coordinating and inserting pegs into a board) than a control group of women who had no history of cancer.
CMF stands for the drugs cyclophosphamide, methotrexate, and 5-fluorouracil (or 5 FU). Animal studies also show that CMF is linked with impaired learning and changes in brain structure and we report on this in Your Brain After Chemo. Yet this recent study, led by Dutch researchers Vincent Koppelmans and Sanne B. Schagen, is the first to show such long-term impairment.

The pattern of memory problems is similar to what patients experience shortly after completing chemotherapy, say the authors who looked at the neuropsychologic test results of 196 women, comparing them to the controls.

Fortunately for newly diagnosed breast cancer patients, oncologists generally no longer prescribe the “M” in CMF.  Instead they replace it with anthracycline-based drugs (ie: doxorubicin instead of methotrexate) which seem to have fewer cognitive side effects. Cyclophosphamide and 5-fluorouracil are still prescribed though and 5-fluorouracil also is linked to post-chemo cognitive decline in some studies.

For those of us in the cancer community who keep a close watch on the research, studies like these – while upsetting – inspire hope that one day soon more effective targeted therapies will kill cancer cells while leaving healthy brain cells intact. -- ID


  1. I was COUNTING on you to put this on your blog into words that the chemobrain challenged would be able to understand! I downloaded the PDF so I can take a week (or ten) to decipher the information. Thanks, Idelle.

    Lou (AnneMarie) Costello

  2. You're so funny, AnneMarie!

    your Bud

  3. Idelle, this is amazing information. My mother was diagnosed with cancer many many years ago, when they were still using CMF. And for years after she finished chemo, she complained that she still was not herself. I'm just discovering your site and book now, but I have to say it sounds amazing! This is something that the doctors never really tell you before you go through this treatment. Also wanted to share a link that was really helpful for my mother when she was going through everything http://onlineceucredit.com/edu/social-work-ceus-can - hope it might help someone else here in some way. And I am off to Amazon to buy this book!

  4. Hi Janice,

    Thank you so much for your note. I think things are getting better, although I still continue to hear similar stories. I've been on my full-disclosure soapbox so much that I'm sure my readers are tired of hearing it. BUT oncologists need to notify their patients IN WRITING about the possibility of these effects as part of the consent process.

    When I was diagnosed six years ago, I had to sign a form acknowledging I had been fully informed of all potential side effects of my chemotherapy drugs. On the form were things like hair loss and nausea. I saw nothing about memory or other cognitive problems, even though a foggy mind could be far more serious and long lasting.

    Some oncologists do mention these effects in writing now, but not all. Even the 30,000-member American Society of Clinical Oncology (ASCO), which sets standards for patient care, does not include memory/cognitive problems on their sample patient consent form!

    [Why, why, why, ASCO? Feel free to respond…]

    Anyway, thanks again, and I do appreciate the link you sent to the syllabus for psychologists and social workers. It’s got some great take-away points about coping with cancer.

  5. I was given methotrexate as part of my treatment four years ago and unfortunately One of the treatments contained ten times the dose due to an error in the Pharmacy. It was discovered later that week and I was given an antidote but I then found I was having severe memory problems. The oncologist like many in your book has discounted my memory problems and it wasn't until I read your book and also the recent research regarding methotrexate that I stopped thinking I was crazy.

    I find that returning to study, as difficult as it has been, using my ipad daily to play word and visiospatial games and improving nutrition has helped. I still struggle to form new memories and now find reading and even watching movies no longer pleasureable. I also find I prefer to watch the same TV series rather than new ones for relaxation.

    I count my blessings daily and as I often say to people, there is an upside as everything is new again every day.

  6. Dear Happydayz, thanks so much for your heartfelt note. Many of my friends had methotrexate as well, and they have had similar experiences. I applaud your stick-to-it strategy of looking for ways to strengthen those parts of your brain that aren't working that great right now.

    Hopefully, just as physical exercise is difficult at first but eventually increases strength and endurance, it is my wish for you that your efforts pay off in sharper memory and focus.

    And speaking about physical exercise, that by the way also helps cognitively by bringing more oxygen to the brain. We know from studies of laboratory animals that exercise creates new neurons in the hippocampus, a region of the brain that is vital to memory and learning.

    I count my blessings daily as well and I am grateful that you and I are part of a larger community of those who care about us and support us. Keep your chin up, continue to eat healthfully and work at those visual-spatial exercises...am sending good thoughts. Hugs.