- Breast cancer is the most common cancer in women, affecting between 1 in 7 and 1 in 8 women in the United Kingdom and United States.
- Treatment is increasingly successful, but people recovering from breast cancer can experience lasting fatigue and cognitive impairment, or ‘brain fog’.
- These symptoms may be a result of both the cancer and the treatments for it.
- Now, a study has found that a nutritional supplement — oxaloacetate — could help alleviate both fatigue and brain fog in people after breast cancer treatment.
Breast cancer is a disease that almost exclusively affects females. According to the
The number of women surviving breast cancer has increased rapidly with improved diagnosis and treatment. In the 1970s, just over 40% of people lived for 10 years after a breast cancer diagnosis; now, almost 80% survive for at least 10 years.
However, during and after breast cancer treatment, many people experience fatigue and cognitive impairment, or ‘brain fog’, which may persist for several years, and can negatively impact quality of life.
“Breast cancer treatments often have significant long-term physical and emotional impacts, which can leave people fatigued or less able to deal with day-to-day activities due to brain fog, and can make adapting to life after treatment extremely challenging.”
– Kotryna Temcinaite, PhD, senior research and impact communications lead at UK Charity Breast Cancer Now.
Now, a small-scale study has found that a nutritional supplement — oxaloacetate — can help to alleviate these symptoms after only 8 weeks of treatment.
Patricia Ganz, MD, lead author on the study, Distinguished Professor Health Policy & Management and Medicine, UCLA Fielding School of Public Health, Los Angeles, told Medical News Today that she was surprised by their findings:
“I was a complete skeptic about the potential benefits of the oxaloacetate, and the consistent findings across the patients were very encouraging, especially the parallel benefits in fatigue, insomnia and physical function—all supporting an important biological response.”
Eight weeks of oxaloacetate treatment for ‘brain fog’
In their phase 2 clinical trial, researchers recruited 18 women who had received a diagnosis of early-stage breast cancer between 1 and 5 years before the start of the trial. All reported significant cognitive difficulties which had persisted following their diagnosis and treatment.
The women had a mean age of 50 years, most had been treated with chemotherapy, and 90% were receiving hormone treatment following their breast cancer.
All participants took 500 milligrams (mg) of oxaloacetate as an oral capsule twice a day for 8 weeks. Some reported mild gastrointestinal side effects, and 2 dropped out of the trial because of gastrointestinal symptoms, but 16 completed the course of treatment.
At the start of the trial, after 4 weeks of treatment, and after 8 weeks of treatment, all participants completed electronic questionnaires. These assessed their cognitive and behavioral symptoms, as well as their overall quality of life, using a symptom checklist of items from the PRO-CTCAE, such as gastrointestinal symptoms, fatigue, pain, insomnia and headache, and the 12-item short-form health survey.
Improvement in cognitive symptoms seen after only 4 weeks
After only 4 weeks of oxaloacetate treatment, all 16 participants reported improvements in their cognitive symptoms. This improvement continued up to the 8 week point, with all participants seeing significant cognitive improvement by the end of the study.
This improvement was reflected in significant increases in their cognitive test scores, from a mean of 29.1 (impaired) at the start of the trial, to a mean of 55.5 (normal) after 8 weeks.
Researchers also observed that participants had significant reductions in fatigue and insomnia, as well as improvements in physical functioning.
Some women saw such a great improvement in their symptoms that they opted to continue the medication, Ganz told MNT:
“Many women continued the drug after the study ended, with the company providing the medications. Some continued to take it for more than a year.”
Why might oxaloacetate improve cognition and fatigue?
Chemotherapy and radiotherapy stimulate a neuroinflammatory response that can result in excess glutamate production, leading to neurotoxic effects, which may result in cognitive symptoms and fatigue.
The authors suggest that oxaloacetate, which is central to energy production in cells, may have beneficial effects through regulating the metabolism of glutamate. By clearing glutamate, oxaloacetate can moderate the effects of neuroinflammation, as well as enhancing the function of mitochondria to regulate energy production within cells.
Rapid move to further trials to verify the findings
Temcinaite cautioned that “this was a very small study involving just 18 women, and from this study we can’t establish whether the supplement oxaloacetate was responsible for the improvements as it lacked a comparison group.”
To answer these questions, the researchers are now planning a larger phase 2 placebo-controlled trial, as well as an animal study to try and work out the mode of action of oxaloacetate.
“I saw each of the participants myself, and clinically evaluated them at each visit,” Ganz told us, “but had no idea that we would see the magnitude and type of changes we saw with the questionnaires and neurocognitive tests. However, after the first 9 patients and review of the data, I was very motivated to complete the study and to move to a definitive efficacy trial.”
“In addition, we moved quickly to be able to study the drug in an animal model, where we see very encouraging results that we hope to publish soon,” she added.
The follow-on phase 2 randomized placebo-controlled trial will require 120 participants, Ganz told us. The researchers will test two doses of oxaloacetate (as required by the Food and Drugs Administration) against placebo, but everyone involved in the trial will be able to receive the drug. Ganz expects to see results within about 2 years.
“Optimism has rarely helped alleviate pain and suffering or cured cancer, so we need to do the trial to get the evidence. There is no reason why oxaloacetate would not be helpful to any cancer patient/survivor suffering from fatigue and cognitive complaints after cancer treatment. Breast cancer was where we had done the most research, but other patient populations will likely benefit.”
–Patricia Ganz, MD
Consult your treatment team before trying any supplement
“We don’t yet know the longer-term effects of taking oxaloacetate,” Temcinaite warned. “Unlike conventional medicines, supplements are not subject to the same regulation or rigorous testing for safety and effectiveness, and they can interact with cancer treatments. If anyone is considering taking any supplements during or after their breast cancer treatment, they should discuss it with their treatment team first.”
She further advised:
“We know it’s not ‘back to normal’ after breast cancer treatment and there are some things you can do to improve your well-being, such as planning your day to balance your activities and rest times, regular physical activity, and eating a healthy well-balanced diet.”
