UAB Nursing Alumna Studies Solutions for Cancer Survivors
By Matt Windsor
Diane Von Ah's research into the causes of "chemo brain" began when she was a doctoral student in UAB's School of Nursing.
In the late 1990s, when Diane Von Ah, Ph.D., was a doctoral student at the UAB School of Nursing, her first research project focused on fatigue in women before and after breast cancer treatment. “Many of the women going through chemotherapy expressed concerns about not being able to think clearly,” says Von Ah, now an assistant professor at the University of Indiana School of Nursing. “This was always a symptom that we didn’t have an answer for,” she says. “The thought was that it was related more to issues related to stress or coping issues.
Von Ah was intrigued by these post-therapy cognitive problems, commonly referred to as “chemo brain,” which include struggles with memory and attention. “Whenever I talk to groups about my research, they bring it up,” Von Ah says. When she surveyed survivors on the subject, “many women told me how frustrated they were that no one would even acknowledge it,” she says. “Even their families; loved ones would tell them, ‘If you loved me, you wouldn’t have forgotten.’”
But a growing body of research, including studies by Von Ah, has substantiated patient reports of cognitive deficits. “I’ve been looking at healthy women versus breast cancer survivors up to 15 years post-treatment,” she says. “We’ve found significant deficits in memory both on neuropsychological exams and subjective tests” when survivors are matched with women of the same age and background.
Von Ah has investigated potential mechanisms underlying chemo brain, including a decline in levels of the neurotransmitter serotonin. “Estrogen is a precursor to serotonin,” Von Ah explains. “Women going through chemo have an immediate transition into menopause. Patients with estrogen-sensitive tumors are put on hormonal therapy to reduce estrogen levels as well.” In a small study led by Von Ah, women whose serotonin levels were depleted quickly in a lab setting demonstrated memory deficits on a neuropsychological exam.
While Von Ah continues to explore the causes of chemo brain, survivors don’t let her forget to focus on a key question: “What can we do about it now?” Brain-training software may offer some help, according to a 2012 study led by Von Ah that also included UAB’s Karlene Ball, Ph.D., chair of the Department of Psychology.
The study looked at 88 survivors with an average of 5.5 years since their last treatment. Participants were assigned to one of three groups: the first used Web-based “brain-training” software, the second was trained in non-computer based memory-boosting strategies, and a third served as the control group. While women in both intervention groups showed improved cognitive function on post-training tests, the brain-training group saw both immediate and lasting cognitive improvements that lasted up to two months after completing a 10-hour training regimen. The researchers also noticed significant improvements in perceived cognitive function, quality of life, and symptoms such as mood disturbance, anxiety, and fatigue.
Another encouraging sign is that “all the women who began therapy actually finished the program,” Von Ah says. “That shows the need.” Future studies will look at the ideal training “dose” and use functional imaging to pinpoint the mechanism of treatment. There is significant interest from breast cancer survivors in this work, Von Ah notes. “I have received requests from people across the nation asking if we are going to open up another trial,” she says. “Chemo brain is impacting their quality of life and how they feel about themselves.”
• UAB nursing professor Karen Meneses, Ph.D., offers additional suggestions to help cancer survivors improve brain function.
• Discover the Young Breast Cancer Survivorship Network in the UAB School of Nursing.