Exercise and ibuprofen help reduce cognitive impairment during chemotherapy

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. 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."

Michelle C. Janelsins, PhD, MPH, lead author, University of Rochester and the Wilmot Cancer Institute

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.