Researchers have already shown that mild to moderate exercise can reduce "chemo brain," and a new study suggests that a low dose of an over-the-counter anti-inflammatory, ibuprofen, can also achieve positive results for cancer patients.
Michelle Janelsins, PhD, MPH , professor of Surgery, Cancer Control, at University of Rochester Medicine, led the study with a team at the Wilmot Cancer Institute . She is a member of Wilmot's Cancer Prevention and Control research program.
For several years, Wilmot researchers have consistently focused on exercise as an intervention for cancer-related symptoms. They have published groundbreaking studies on how various forms of exercise — walking, resistance bands, yoga — can lessen the burden of cancer-related cognitive issues, fatigue, anxiety, and insomnia. The latest study also had patients taking 200 mg of ibuprofen (one pill) twice a day.
The journal Cancer, of the American Cancer Society, published the latest study, a phase 2 clinical trial.
Up to 80% of patients report brain fog during and after cancer treatment, labeling it "chemo-brain" to describe difficulty with memory, paying attention, and multitasking.
The study showed that both exercise and ibuprofen — alone or in combination — lessened the fog, although exercise appeared to be the most beneficial, even if a person is starting out sedentary or not feeling well on certain days.
"Having patients do as much as they can is better than nothing," Janelsins said.
Research "Firsts"
Anti-inflammatory medicines in this setting have been studied pre-clinically, but Janelsins believes this is the first study to look at ibuprofen in individuals taking chemotherapy who reported cognitive problems.
One unique way that researchers measured improvement was to note the observations of a patient's family members and friends.
Another thing that sets this study apart from others, Janelsins said: Researchers intentionally designed the study to address alleviating chemo-brain as an outcome. Another major strength of this study was to include objective, performance-based cognitive tests and patient-reported outcomes.
"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," Janelsins said.
Ibuprofen Worked Well, but Exercise is Still Essential
Researchers randomized 86 cancer patients from Rochester and throughout upstate New York, who were receiving chemotherapy and reported cognitive problems, to one of four study arms for six weeks.
The first arm included a proprietary exercise program founded at the URochester Medicine called Exercise for Cancer Patients (EXCAP©®) + low-dose Ibuprofen. The second group received EXCAP plus a placebo; the third group received low-dose Ibuprofen alone, and the fourth group received only a placebo. (EXCAP©® is a home-based, low-to-moderate intensity, progressive walking and resistance exercise prescription.)
After six weeks, participants in the EXCAP plus placebo group demonstrated significantly better attention compared with the placebo group. The ibuprofen-only group also showed greater improvements than the placebo group.
The group who received exercise plus ibuprofen or exercise alone exhibited improvements that were noticeable by family and friends.
The findings suggest that ibuprofen may help improve some cognitive functions, but perhaps to a lesser extent and less consistently than exercise.
Although no adverse events were reported in this study, Janelsins emphasized that patients with chemo-brain should discuss any interventions they are planning to use with their oncology team to avoid potential harmful effects or drug interactions with existing medications.
Janelsins and her team are also analyzing results of a larger, nationwide phase 2 clinical trial that also evaluates low-dose ibuprofen and are planning for phase 3 trials for both exercise and low-dose ibuprofen.
"Since we saw cognitive benefits in some domains and not others," Janelsins said, "we will also consider additional doses and longer durations in future research trials."
