Intimate relationships may protect against cognitive decline during chemotherapy

Intimate relationships may protect against cognitive decline during chemotherapy

A satisfying intimate relationship may help reduce chemotherapy-related cognitive problems experienced by breast cancer patients, a new study suggests.

Overall social support was also protective, but the association was less robust and durable than a satisfactory intimate partnership, characterized by fewer declines in both objective measures of cognitive setbacks and patient self-reports of subtle changes such as forgetting grocery list items and being unable to multitask.

The results suggest that couples therapy, which aims to improve relationship quality, could be a helpful option for partner patients undergoing chemotherapy, researchers say.

The team also found that blood levels of the hormone oxytocin, a key player in social bonding, decreased significantly over the course of chemotherapy, suggesting a biological mechanism that may one day aim to reduce chemo's side effects.

"There are many cancer treatments, but there are very few treatments for the side effects of cancer. So we need to understand how they happen in order to create useful interventions for the side effects," said senior author Leah Pyter, director of the Institute of Behavioral Medicine at Ohio State University and associate professor of psychiatry and behavioral health in the Center for Medicine.

“Prior to this study, we did not understand that strengthening the intimate relationship before the patient undergoes chemotherapy could mitigate their cognitive side effects.”

The research was recently published in the journalPsychoneuroendocrinology.

The 48 participating women with breast cancer were part of a larger study examining the links between chemically induced disruption of the gut microbiome, inflammation and cognitive decline.

Participants completed objective tests assessing verbal learning, word association, visual attention, and short-term memory. Separately, they reported changes in their concentration, memory, word recall, and mental clarity, and how declines affected their quality of life. These measures were taken before, during and after chemotherapy.

The decline in intellectual ability did not meet the clinical definition of cognitive impairment, but several changes were considered clinically meaningful.

It was nice to test these patients before they had chemotherapy and then again after, because people can be affected by chemo and still be in normal ranges - but for them it's not normal. “

Leah Pyter, director, Institute for Behavioral Medicine Research, The Ohio State University and associate professor of psychiatry and behavioral health in the College of Medicine

For this study, first author Melina Seng, then a master's student and now a senior research technician in Pyter's laboratory, worked with the partner patients to assess their intimate relationship satisfaction and social support from friends and family during chemotherapy.

Statistical analysis revealed associations between changes in cognitive scores and social factors, finding that the more cognitive changes occurred over the course of chemotherapy, the more protected patients were in their relationship.

"There was less cognitive functioning for those who had good social support, but there were more associations and more lasting associations between protected cognition and the very satisfying relationship than with just general social support," Pyter said. “We interpreted this as an indication that the most important social relationship is this intimate partnership.

"There is a group therapy for chemotherapy that is social support, and this study would suggest that while this therapy may be beneficial, spousal or partner therapy in other medical contexts to improve relationship quality may be a good approach for patients receiving chemotherapy."

While Seng hoped to find associations between oxytocin levels, cognitive function and social support, no clear links could be found. However, the results showed that the hormone and its receptor were affected by chemotherapy.

Specifically, circulating blood levels of oxytocin significantly decreased during chemotherapy and returned to baseline levels after treatment, suggesting that chemotherapy may affect the hypothalamic region of the brain where oxytocin is produced.

"Oxytocin is known for roles in social interactions and has been called the hormone 'love,' but it does so many other things," Seng said. “To our knowledge, no one has studied oxytocin and chemotherapy, so the fact that we saw a very large decrease in oxytocin from pre-chemotherapy to chemotherapy is very interesting and should be studied further.”

Both Pyter and Seng noted that with increased breast cancer survival there is an urgent need to address persistent side effects of treatment.

"Chemotherapy is one of the best treatments we have for cancer and other diseases beyond cancer. It affects many people and is very effective," Pyter said. "We have more survivors, which is fantastic. Our research is focused on issues that are less well studied and trying to ensure that the quality of life for survivors is as high as possible."

This work was supported by the National Center for the Advancement of Translation Studies and The Ohio State University Wexner Medical Center.

Additional co-authors, all from Ohio State, were Seth Adarkwah Yiadom, Lauren Otto-Dobos, Sagar Sardesai, Nicole Williams, Margaret Gatti-Mays, Daniel Stover, Preeti Sudheendra, Erica Dawson, Robert Wesolowski, Baldwin Way, Erica Glasid and Rebecca.

Sources: