One of the most problematic side effects of cancer treatment, chemobrain -- a range of symptoms including memory loss, inability to concentrate, difficulty thinking and other subtle cognitive changes following chemotherapy -- seriously diminishes women's quality of life and daily functioning. As a result, they have to adopt a range of coping strategies to manage their restricted social and professional lives.
Breast cancer survivors tell their story in a descriptive study of the effects that cognitive impairment has on women's work, social networks and dealings with the health care profession. Dr. Saskia Subramanian from the UCLA Center for Culture and Health in the US and her colleagues have just published their work online in Springer's Journal of Cancer Survivorship.
An increasing number of women survive breast cancer, yet survival comes at a price. Mild cognitive impairment following chemotherapy, known as "chemobrain" or "chemofog" is one of the most commonly reported post-treatment symptoms by breast cancer survivors. Dr. Subramanian and colleagues' work shows that this deterioration in brain function has devastating effects on breast cancer survivors' quality of life.
Through a combination of focus groups and in-depth interviews among 74 women who had completed their course of cancer treatment at least a year earlier, the researchers gathered data on patients' medical background, treatment experience, post-treatment symptoms, reactions from medical staff and from family and friends, self-management, strength of social networks and their perceptions of themselves.
The women described a variety of cognitive changes which they found both frustrating and upsetting. Some were less able to retain material or to digest new information and recognized that they were not functioning as they once did. Others faced reduced independence, becoming limited in their ability to manage certain responsibilities or get around. These changes made women feel scared, dependent and emotionally drained. For some, coping meant having to cut back on work and social activities. Others had more or less accepted the limitations put on their lives and resigned themselves to a diminished cognitive capacity.
The majority of women complained about the lack of acknowledgement from the medical community when they mentioned their chemobrain symptoms. Many women wished they had received some warning and only a few got answers from their physicians. Some women felt that chemobrain confused their families and friends, and young children in particular.
Chemobrain also affected women's performance at work. Because they were less able to focus, duties became more difficult and often took longer. This affected their efficiency and reduced their chances of promotion or assignment to projects.
The authors conclude: "These data underscore the very serious ways in which chemobrain can affect the life experiences of cancer survivors - emotionally, psychologically and economically. A clear understanding of the cognitive impairments experienced by survivors will aid researchers in developing targeted therapies and interventions aimed at improving or mitigating these post-treatment side effects."
- Boykoff N, Moieni M, Subramanian S. Confronting chemobrain: an in-depth look at survivors’ reports of impact on work, social networks, and health care response. Journal of Cancer Survivorship, 2009; DOI: 10.1007/s11764-009-0098-x
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