Awareness of Cognitive Impairments from Breast Cancer Treatment

October 2, 2017

Coral Omene, MD, PhDBy Coral Omene, MD, PhD

It is now well known that up to 75 percent of women experience deficits in their intellectual capacity (i.e., cognitive impairment) during or after breast cancer treatment. Patients typically complain that they are “forgetful” and have “trouble concentrating or remembering” details like names, dates, and important events. They have difficulty multi-tasking, and it takes them longer to complete a task. Unfortunately for some women, these symptoms can persist for many months or years. These mental deficits are variable; they may be subtle or striking and temporary or permanent. Given that we continue to make strides in medicine to improve survival rates in breast cancer, there will be many more women living with cognitive impairment and it is important to not only be aware of but to address these issues, so that the quality of life for these women is maintained.

Previously these cognitive difficulties were all attributed to chemotherapy such that the term “chemo brain” was coined. However, we now know that it is multifactorial. The menopausal status of the woman and endocrine (hormonal) therapy she receives for treatment can also influence cognitive function. Studies show that breast cancer patients who received chemotherapy and the anti-estrogen therapy tamoxifen have greater difficulty than those who received chemotherapy alone. Typical risk factors that can impact cognitive impairment from breast cancer treatment include being of elderly age and the intensity or number of chemotherapy doses received. There are also psychosocial risk factors like fatigue, anxiety, and depression. Other factors that can worsen the symptoms include drugs like pain killers, sleep disturbances, anemia and poor nutrition.

Currently, there is no known way to prevent the cognitive difficulties caused by treatment. Medications like psychostimulants which can be prescribed by a doctor may help, but there are non-medicinal options that patients can explore. They include mind training exercises like puzzles, as well as games that use memory or learning a new language. Exercise, stress management, good nutrition filled with antioxidant-containing foods such as fruits and vegetables have also been recommended. Organization can be very helpful. Patients should set up and follow structured routines and use a detailed daily planner to keep track of appointments and schedules. Patients may sometimes feel embarrassed and not reach out for help. It is important to remember that these mental difficulties are a side effect that can be managed. Patients should ask for help from friends and loved ones and importantly inform their doctors for additional support.

Sources: The American Cancer Society; National Cancer Institute; Ahles TA, ASCO Post, 2016

Coral Omene MD, PhD, is a medical oncologist in the Stacy Goldstein Breast Cancer Center at Rutgers Cancer Institute of New Jersey and an assistant professor of medicine at Rutgers Robert Wood Johnson Medical School. 

 

 

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