Confronting chemobrain: an in-depth look at survivors’ reports of impact on work, social networks, and health care response

IntroductionMild cognitive impairment following chemotherapy is one of the most commonly reported post treatment symptoms by breast cancer survivors. This deterioration in cognitive function, commonly referred to as “chemobrain” or “chemofog,” was largely unacknowledged by the medical community until recent years. Although chemobrain has now become the subject of more vigorous exploration, little is known about this specific phenomenon’s psychosocial impact on breast cancer survivors. This research documents in-depth the effects that cognitive impairment has on women’s personal and professional lives, and our data suggest that greater attention needs to be focused on this arena of survivorship.MethodsThe results are based on an in-depth qualitative study of 74 white and African American breast cancer survivors in California who experience post-treatment side effects. The data reported herein were obtained through the use of focus groups and in-depth interviews.ResultsOur data indicate that cognitive impairment can be problematic for survivors, with many asserting that it is their most troublesome post treatment symptom. Survivors report diminished quality of life and daily functioning as a result of chemobrain. Respondents detail a range of coping strategies that they are forced to employ in order to manage their social and professional lives.Discussions/conclusionsChemobrain significantly impairs a proportion of cancer survivors, at great cost to them economically, emotionally, and interpersonally. This suggests that more research needs to be conducted on the psychosocial ramifications of post treatment symptoms in order to inform the efforts of the medical and mental health communities as well as the support networks of survivors.Implications for cancer survivorsA better and broader understanding of the effects of cognitive impairment both in the medical community and among lay people could pave the way for improved social and psychological services for this population.

[1]  M Abdolell,et al.  Cognitive function in breast cancer patients receiving adjuvant chemotherapy. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  M. Wieneke,et al.  Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer , 1995 .

[3]  S. Sereika,et al.  Cognitive impairment associated with adjuvant therapy in breast cancer , 2006, Psycho-oncology.

[4]  Michael E. Phelps,et al.  Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5–10 years after chemotherapy , 2007, Breast Cancer Research and Treatment.

[5]  M. Muller,et al.  Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma , 1999, Cancer.

[6]  R. Theriault,et al.  ‘Chemobrain’ in breast carcinoma? , 2004, Cancer.

[7]  T. Ahles,et al.  Renaming “Chemobrain” , 2007, Cancer investigation.

[8]  I. Tannock,et al.  Cognitive function, fatigue, and menopausal symptoms in breast cancer patients receiving adjuvant chemotherapy: evaluation with patient interview after formal assessment , 2006, Psycho-oncology.

[9]  S. Allan,et al.  A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer , 2006, British Journal of Cancer.

[10]  Andrew J Saykin,et al.  Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  V. Shilling,et al.  Self-reported cognitive problems in women receiving adjuvant therapy for breast cancer. , 2007, European journal of oncology nursing : the official journal of European Oncology Nursing Society.

[12]  P. Ganz Cognitive dysfunction following adjuvant treatment of breast cancer: a new dose-limiting toxic effect? , 1998, Journal of the National Cancer Institute.

[13]  V. Shilling,et al.  The effects of adjuvant chemotherapy on cognition in women with breast cancer--preliminary results of an observational longitudinal study. , 2005, Breast.

[14]  S. E. Grober Resources for treatment of chemotherapy-related cognitive difficulty. , 2002, Cancer practice.

[15]  S. Sereika,et al.  Cognitive function and reproductive hormones in adjuvant therapy for breast cancer: a critical review. , 2001, Journal of pain and symptom management.

[16]  J. Holland,et al.  Cognitive Function of Older Patients Receiving Adjuvant Chemotherapy for Breast Cancer: A Pilot Prospective Longitudinal Study , 2006, Journal of the American Geriatrics Society.

[17]  M. Fitch,et al.  Patients' experiences with cognitive changes after chemotherapy. , 2008, Canadian oncology nursing journal = Revue canadienne de nursing oncologique.

[18]  Paul Maruff,et al.  The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: A meta-analysis of the current literature , 2005, Brain and Cognition.

[19]  P. Jacobsen,et al.  Cognitive functioning after adjuvant chemotherapy and/or radiotherapy for early‐stage breast carcinoma , 2005, Cancer.

[20]  C. Nelson,et al.  Chemotherapy and cognitive deficits: Mechanisms, findings, and potential interventions , 2007, Palliative and Supportive Care.

[21]  M. Lorentzon Doing Qualitative Research , 1993 .

[22]  R. Raffa,et al.  Is ‘chemo‐fog’/‘chemo‐brain’ caused by cancer chemotherapy? , 2006, Journal of clinical pharmacy and therapeutics.

[23]  P. Ganz,et al.  Neurocognitive Performance in Breast Cancer Survivors Exposed to Adjuvant Chemotherapy and Tamoxifen , 2004, Journal of clinical and experimental neuropsychology.

[24]  Y. Ohashi,et al.  Mild cognitive impairment after adjuvant chemotherapy in breast cancer patients - evaluation of appropriate research design and methodology to measure symptoms , 2005, Breast cancer.

[25]  D. Butterfield,et al.  Adriamycin‐mediated nitration of manganese superoxide dismutase in the central nervous system: insight into the mechanism of chemobrain , 2007, Journal of neurochemistry.

[26]  G. Jackson Chemo brain - a psychotropic drug phenomenon? , 2008, Medical hypotheses.

[27]  David Schiff,et al.  Neurologic complications of chemotherapy agents , 2007, Current opinion in neurology.

[28]  S. Rodenhuis,et al.  Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. , 1998, Journal of the National Cancer Institute.