Memory and Concentration Problems on Tamoxifen - Sound Familiar?
When Pamela Munster, an American oncologist, talked to a room of breast cancer survivors about taking tamoxifen for ten years instead of five, questions about side effects came in like rockets. It was clear that very few women cruise through hormone therapy without issues.
One of the most common side effects mentioned was “brain fog” – memory loss and concentration issues brought on by use of tamoxifen or aromatase inhibitors. With recent studies and oncologists like Dr Munster telling us that ten years on those drugs carry greater survival benefits than five, combatting side effects seems more important than ever.
Dr David Porter, at Auckland Hospital, is one of the principal investigators on the MagLev trial, which is looking at using magnesium to mitigate those memory and concentration issues. Over his career many patients have come to him with cognitive side effects. “It’s quite a significant issue for women,” he says, “and we know that when women come off hormone therapy their cognition improves.”
Porter believes this problem doesn’t start in the brain, but in the kidneys. Recent studies have shown that when estrogen is blocked or depleted, as it is during hormone therapy, magnesium is lost from the kidneys. That’s led him to believe that low magnesium levels in the body can lead to memory and concentration issues; people with Alzheimer’s disease tend to have low levels of magnesium too.
The idea of the MagLev trial is to give magnesium to women on tamoxifen or aromatase inhibitors, and see if their cognition changes in the space of three months, in comparison to another group of women who will be taking a placebo.
Dr Porter thinks clinical trials like this one are critically important. Hormone therapy can decrease a woman’s chance of breast cancer recurring significantly. But, as oncologists like David Porter know all too well, if the side-effects of a treatment make life too difficult, then patients will tell their doctors that they just can’t take the drug anymore.
“We have so many women coming to us saying ‘look, my brain’s fried, I can’t function at work, and I can’t concentrate.’ So this is an attempt to fix this problem so that women don’t have to stop treatment.”
If the MagLev trial shows that magnesium can help alleviate cognitive symptoms like memory loss and concentration issues, women experiencing these problems could stay on their medication for longer, benefiting from the protection the therapy provides against relapse. As well, patients would be better able to think, work, and interact; benefits that are more important than any kind of survival statistic.
The MagLev trial is currently recruiting participants in Auckland, Palmerston North and Christchurch. If you’d like to be involved, get in touch with Christine Crooks - c.crooks@auckland.ac.nz or 0274 053 284.