Memory Loss and Chemotherapy
- Dr. Favia Dubyk survived Hodgkin lymphoma and then went on TV for an insane fitness challenge. She’s also a cancer doctor who rock climbs professionally.
- Dubyk says she suffers from memory loss that resulted from chemotherapy treatments.
- According to our experts, regular exercise can help with prevention and with recovery of “chemo brain” – a sense of mental cloudiness experienced by patients being treated with chemotherapy.
Dubyk was 24 when doctors found a 13cm mass in her chest. At the time, she was in her third year of medical school at Case Western Reserve University School of Medicine after getting an undergraduate degree from Harvard and her master of science from Columbia.Read More
Three weeks after her initial biopsy, she was finally diagnosed with Hodgkin lymphoma.
“I am eternally grateful to the pathologists who worked tirelessly on my case to make my diagnosis,” she wrote. “They allowed me to move forward with my life, find my purpose and that’s what inspired me to become a pathologist and start my own medical education clinic.”
Her clinic, Dr. Favia’s Diagnosis Education Clinic, gives Dubyk the chance to answer whatever pathology-related questions patients have about their diagnoses and explain how those diagnoses were made in the first place. For the uninitiated, this means Dubyk answers questions about lab work and test results which are used to drive decision making about treatment.
“Today, I get to help patients like myself who are searching for answers during scary and uncertain times,” she said.
And while she’s doing well today, chemotherapy left her with some lasting impacts. In a recent Instagram post, Dubyk talked about her chemotherapy-caused memory issues.
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“I often forget that I have amnesia, a side-effect of chemotherapy. I lost about two years of memories around my treatment,” she wrote in her caption. “Recently, I saw a pair of boots that gave me a flashback to a vague, unclear memory that I hadn’t thought about since I got sick. This is the first time an object has sparked a lost memory. Now, it’s got me wondering what else I have forgotten! Maybe I knew how to dyno??”
So, despite lasting impacts from her cancer journey, Dubyk has an amazing attitude about her whole experience and advises other cancer warriors to keep their heads up.
“During chemotherapy and the subsequent recovery, I thought about all things I wanted to do again,” she wrote. “Sometimes it was as small as finishing a TV show or ranking first in a video game. Other times it was something bigger, like touching real rock again or practicing medicine. Just dreaming about those things made the day to day hardships much more tolerable! My advice to you is to never lose hope or sight of who you are. Remember, cancer is just a chapter in your life – it’s not your whole story.”
Understanding Hodgkin Lymphoma
Lymphoma, in general, is a cancer of the immune system that begins in the white blood cells called lymphocytes. There are more than 40 different types of the disease, but Hodgkin lymphoma – like Favia Dubyk had – and non-Hodgkin lymphoma are the main two sub-categories with the latter being more common.
According to the Leukemia & Lymphoma Society, about 90,390 people in the United States are expected to be diagnosed with lymphoma in 2021 – 8,830 cases of Hodgkin lymphoma and 81,560 cases of Non-Hodgkin lymphoma. The type of white blood cells linked to the disease determines the distinction. If doctors are unable to detect the Reed-Sternberg cell – a giant cell derived from B lymphocytes – then it is categorized as Non-Hodgkin lymphoma. Hodgkin lymphoma is most often seen in younger adults, like Dubyk.
Dr. Elise Chong, a medical oncologist at Penn Medicine, explained that lymphoma symptoms can be difficult to detect. Doctors first thought Dubyk’s asthma was acting up when she started having symptoms.
“The symptoms of lymphoma, especially if you have a low-grade lymphoma, often are no symptoms,” Dr. Chong explained. “People say, but I feel completely fine, and that’s very normal.”
Side Effects of Chemotherapy on the Brain
Chemotherapy is a possible treatment option for many cancers, including Hodgkin lymphoma. Dubyk said her amnesia was chemo-related, but one of our experts tells us that total amnesia, or memory loss, for any significant amount of time is unlikely to be a side effect of this treatment. But “chemo brain” – a sense of mental cloudiness experienced by patients being treated with chemotherapy – is a fairly common side effect of the treatments. Patients who experience “chemo brain” can have trouble finishing tasks, completing sentences, remembering things, focusing and even performing other kinds of cognitive activities that would not have been difficult prior to treatment.
“The dysfunction is usually temporary and clears within a year of starting treatment,” Dr. Douglas Blayney, a medical oncologist at Stanford Health Care, previously told SurvivorNet. “For some people, its effects are more long lasting, and may never completely resolve.”
Unfortunately, there aren’t really any medication or diet interventions that have been shown to help, according to Dr. Blarney, but there is one thing survivors can do to try to help the condition.
“The most robust finding thus far is that regular exercise can help with prevention and with recovery,” he said. “Exercise, of both the body and the brain, are the best proven treatments.”
In fact, a recent study published in the Journal of Clinical Oncology by researchers at Washington University School of Medicine in St. Louis suggested that physical activity may be a helpful defense against some kinds of cognitive decline experienced by breast cancer patients undergoing chemotherapy.
The breast cancer patients – assessed right before starting chemotherapy, right after finishing chemo and six months after completing chemo – all experienced some level of cognitive decline over the course of chemotherapy. But those who kept exercising throughout treatment did better on cognitive tests than those who did not exercise or were inconsistent.
“Patients who were always meeting guidelines, staying consistently active during treatment, demonstrated better cognitive function scores after chemotherapy. They also had a better cognitive recovery six months after chemotherapy was over. They actually recovered to their pre-chemo level of cognition,” study author Dr. Elizabeth Salerno told SurvivorNet. “These findings support continued promotion of physical activity during cancer survivorship as early as possible.”
Still, Dr. Salerno said there were limitations to the study.
“Measuring cognition after cancer is tricky,” she said. “It’s difficult for us to say how well our measurements capture all of the very nuanced connected changes that may be occurring in the brain after cancer diagnosis and treatment.”
Dr. Salerno also emphasized that physical activity didn’t have to be a massive effort in order to make a difference.
“Physical activity doesn’t have to look like a Jillian Michaels program,” she said. “It can simply be moving more throughout the day.”
Other Chemotherapy Side Effects
Chemotherapy treatments affect everyone differently, so there’s no real definite side effects you can count on. Below are some of the more common side effects that can affect patients during and after chemo treatments. And while it’s important to note that we’ve come a long with the management of these side effects, they can still have a great impact on people throughout their cancer journeys.
“One of the things that patients worry most about is nausea with chemotherapy,” Dr. Michael Ulm, gynecologic oncologist at West Cancer Center, said in a previous interview with SurvivorNet. “Everybody remembers what their parents went through or what their aunts and uncles went through probably 15 or 20 years ago.”
Although people can still anticipate nausea, Dr. Ulm says your nausea shouldn’t be as bad as you’re imagining with today’s arsenal of effective treatments to combat the side effect with medications you can even take at home.
“I tell my patients, with modern medicine and modern antiemetics that you should never have severe nausea and you should never throw up,” Dr. Ulm said.
Hair Loss or Thinning
Many chemotherapies can cause hair loss or thinning. Hair loss typically begins about three to four weeks after a woman begins chemotherapy and continues throughout treatment. Woman can expect regrowth around four to six weeks after they complete treatment, but some patients may experience some changes to hair color and texture when it begins growing back.
The hair loss associated with chemo is temporary, but this can be an incredibly distressing side effect for some. It’s important to speak with your doctor about any personal issues that may be caused by treatment side effects including the loss or thinning of your hair. To help patients cope with hair loss, a doctor or nurse may be able to recommend a local wig-maker or other resources that can help slow down the process.
Cardiotoxicity, or problems in the heart and vascular (circulation) system, can be a side effect of chemotherapy. Although uncommon, cardiovascular disease is the second leading cause of death among breast cancer survivors – behind only secondary malignancies – due, in part, to the damage some cancer therapies can cause to the heart.
“From chemotherapy, high doses of anthracyclines, in particular, have been the prototype of cancer therapies that lead to cardiotoxicity,” Dr. Emanuel Finet, a transplant cardiologist at Cleveland Clinic Cancer Center, previously told SurvivorNet.
Cancer patients at a high risk for heart problems can be older, younger with more aggressive chemotherapy, obese, smokers or dealing with pre-existing cardiovascular disease.
Blood-forming Cell Damage
Chemotherapy drugs can damage all three types of blood-forming cells: red blood cells, platelets and white blood cells. This is turn can lead to various issues like anemia (low red blood cell count), thrombocytopenia (low blood platelet account) or neutropenia (low number of a type of white blood cell called neutrophil).
“One of the things that’s changed in the coronavirus days is that now we’re giving everybody this drug called Neupogen or Neulasta, and it helps boost your white [blood cell] count,” Dr. Ulm said as a way to help your body fight infections.
Fatigue is another possible symptom that has the potential to worsen as chemo cycles add up. If chemotherapy left you with anemia, you can try treating that ease exhaustion. But rest breaks, frequent exercise, and getting plenty of sleep at night can also help fight fatigue.
In an earlier interview, Dr. Zachary Reese, a Medical Oncologist at Intermountain Healthcare, spoke with SurvivorNet about what chemotherapy-related fatigue is like.
“What I typically tell patients is that [chemotherapy] is a bit of a roller coaster ride,” he said. “You’re going to feel tired about a week into treatment, and that’s when you’ll hit bottom. And then you’ll start to come back up again just in time to do it all over… You’ll feel a little more tired the second time around than you did the first, and it will last a day longer.”
Nerve damage, or neuropathy, can leave you with symptoms like ‘pins-and-needles,’ pain, burning, numbness, weakness or trouble detecting heat and cold.
These symptoms might worsen as your chemo treatments progress, but there are ways to combat them. Steroids, numbing patches or cream, antidepressant medicine, anti-seizure medication physical therapy, relaxation techniques, acupuncture or dosage adjustments may help with these symptoms. And while the symptoms of nerve damage might go away once you finish treatment, there can be lasting effects that require ongoing treatments.