Summary: Up to 80% of cancer patients undergoing chemotherapy suffer from “cancer-related cognitive impairment,” a fog of memory lapses and focus issues often dubbed “chemo brain.” A new Phase II clinical trial offers a potential solution.
The study found that a home-based exercise program and low-dose ibuprofen can both mitigate these cognitive declines. While both showed promise, exercise emerged as the more consistent and powerful tool for keeping the mind sharp during treatment.
Key Findings
- Exercise Wins on Attention: Participants in the EXCAP + Placebo group showed significantly better performance in attention tasks compared to the group receiving no intervention.
- The Ibuprofen Paradox: While ibuprofen improved some cognitive scores, it surprisingly showed less improvement in short-term verbal memory compared to those not taking the drug, a quirk that researchers say requires further investigation.
- Social Confirmation: Both the exercise-only and the exercise-plus-ibuprofen groups saw improvements in how family and friends perceived the patient’s cognitive health, suggesting the benefits are noticeable in daily social interactions.
- Pronounced Physical Benefit: Dr. Janelsins noted that while ibuprofen has potential, the effects of exercise were far more pronounced and consistent across the study.
Source: Wiley
Up to 80% of people who receive chemotherapy experience cancer-related cognitive impairment, which most commonly involves mild-to-moderate changes such as difficulty paying attention, memory lapses, and struggles with multitasking.
A new Phase II trial found that exercise and low-dose ibuprofen can each help to lessen cognitive problems and help protect patients’ cognitive function.
The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Both exercise and anti-inflammatory medications can improve cognitive outcomes in a variety of disease settings, but little is known in the setting of cancer. Because exercise and ibuprofen both reduce inflammation through different pathways, their combined use could potentially have additive or synergistic effects on lessening cancer-related cognitive impairment.
To investigate, researchers randomized 86 patients with cancer receiving chemotherapy who reported cognitive problems to four study arms for six weeks: Exercise for Cancer Patients (EXCAP) + low-dose ibuprofen, EXCAP + Placebo, low-dose ibuprofen only, and Placebo only. (EXCAP is a home-based, low-to-moderate intensity, progressive walking and resistance exercise prescription.)
After six weeks, participants in the EXCAP + Placebo group demonstrated significantly better attention performance compared with the Placebo group. The ibuprofen-only group also showed greater improvements than the Placebo group.
Compared with Placebo participants, both EXCAP + ibuprofen and EXCAP + Placebo participants exhibited improvements on a measure that assessed how often friends, family, or coworkers have commented on or noticed the patient’s cognitive difficulties.
However, the ibuprofen group showed less improvement on a measure of short-term verbal memory compared with those not on ibuprofen, which needs to be further investigated.
The findings suggest that exercise can positively impact cognitive function in individuals receiving chemotherapy. Ibuprofen may also help improve some cognitive functions, but perhaps to a lesser (and less consistent) extent. Phase III trials are needed to explore these findings further.
“We are encouraged by the findings of this trial that suggest possible benefits of both interventions for some cognitive domains. Clearly, we saw a more pronounced effect with exercise, which is notable considering the multiple health benefits of exercise for cancer survivors,” said lead author Michelle C. Janelsins, PhD, MPH, of the University of Rochester and the Wilmot Cancer Institute.
“This is one of the first studies specifically designed to assess these interventions for cancer-related cognitive impairment during chemotherapy in patients with multiple diseases using both performance-based cognitive assessments and patient-reported outcomes.”
Dr. Janelsins noted that future studies should consider modifying the duration and dose of both the exercise and low-dose ibuprofen interventions. She also stressed that any intervention for cognitive problems should be discussed with a health care provider to ensure there are no contraindications.
Key Questions Answered:
A: In this study, a low-to-moderate walking and resistance program (EXCAP) was safe and effective. However, chemotherapy affects everyone differently. Always get your oncologist’s “green light” before starting a new fitness routine.
A: The study showed ibuprofen had some benefits, but they were inconsistent and actually seemed to hinder verbal memory in some tests. Exercise was the clear “gold standard” in this trial for protecting cognitive function.
A: Chemotherapy can trigger systemic inflammation that crosses the blood-brain barrier, affecting areas responsible for “executive function”, your ability to multitask, pay attention, and recall details.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this neurology research news
Author: Sara Henning-Stout
Source: Wiley
Contact: Sara Henning-Stout – Wiley
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Phase II Trial of Exercise and Low-Dose Ibuprofen for Cancer-Related Cognitive Impairment in Patients Receiving Chemotherapy” by Michelle C. Janelsins, Riham A. Alieldin, Tyler Holler, Hongying Sun, Po-Ju Lin, Michelle Shayne, Alissa Huston, Kassandra Doyle, Michelle Porto, Mohamedtaki Tejani, Bryan Thompson, Allison Magnuson, Marcia Krebs, Richard F. Dunne, Supriya G. Mohile, Chin-Shang Li, Umang Gada, Ajay Dhakal, Aram F. Hezel, Marcus S. Noel, Alok A. Khorana, Brian D. Yirinec, Nayana Kamath, David W. Dougherty, Tim A. Ahles, Gary R. Morrow, and Karen M. Mustian. Cancer
DOI:10.1002/cncr.70323
Abstract
Phase II Trial of Exercise and Low-Dose Ibuprofen for Cancer-Related Cognitive Impairment in Patients Receiving Chemotherapy
Background
Interventions for cancer-related cognitive impairment are understudied, particularly during therapy.
Methods
Patients with cancer receiving chemotherapy reporting cognitive problems were randomized to one of four study arms for 6 weeks in this phase 2 randomized controlled trial with a 2 × 2 factorial design. Study arms included: Exercise for Cancer Patients©® (EXCAP)–ibuprofen, EXCAP–placebo, ibuprofen only, and placebo only. EXCAP is a home-based, low to moderate-intensity, progressive walking and resistance exercise prescription. Cognitive and biologic assessments were conducted at baseline and post-intervention.
Results
Eighty-six participants were randomized (mean age, 53.60; 88.37% female). Between-group analyses showed that participants in the EXCAP–placebo group demonstrated significantly better attention performance on the Trail Making Test compared to the placebo group (−21.57 seconds, p < .001; Cohen’s d = –1.31; 95% CI, –2.18 to –0.44; lower times indicate better performance).
The ibuprofen only group showed greater improvements than the placebo group (−11.27-second difference, p = 0.05; Cohen’s d = –0.73; 95% CI, –1.57 to 0.11). Both EXCAP–ibuprofen and EXCAP–placebo participants exhibited improvements on the FACT-Cog “comments from others” compared to placebo (Cohen’s d = 1.00; 95% CI, 0.35 to 1.65 and Cohen’s d = 0.65; 95% CI, –0.01 to 1.31).
On Rapid Visual Processing mean latency, participants in the EXCAP-placebo group had a significant improvement compared to placebo (Cohen’s d = −1.10; 95% CI, −1.97 to −0.23); those receiving ibuprofen had an improvement compared to placebo, which revealed a trend after adjusting for reading score (Cohen’s d = −1.04; 95% CI, −2.06 to −0.01).
The ibuprofen group performed less well on the Hopkins Verbal Learning Test-Revised delayed compared to those not receiving ibuprofen (Cohen’s d = –0.64; 95% CI, –1.21 to –0.07).
Conclusions
Exercise and low-dose ibuprofen improved some domains of cognitive function, although effects were not observed across all measures. Phase 3 trials are needed.
