I chose this picture, because it really does look like a portrait of me when I was a young nurse in my 20's. Thought I would introduce a new thread - where I can share some of health care issues and treatment I see everyday. Thought maybe we could start with some facts of information - and hoping we can then discuss it. So here we go - Topic #1
A Real Mystery
Researchers are just beginning to recognize the cognitive side effects of chemotherapy.
As far back as the 1980's, people with cancer have talked about and reported memory and concentration difficulties they believed were related to their chemotherapy treatments. Dubbed "chemobrain" by patients, the healthcare industry has only recently taken the phenomenon seriously and begun to study it as a possible side effect to chemotherapy.
Although research is still in it's infancy, chemobrain, or 'chemotherapy-related cognitive dysfunction, is not recognized as a variety of side effects that can range from diminished executive function to reduced verbal memory. Patients often compare chemobrain to living in a fog and report that the effects can last from weeks to years.
Many unknowns still exist about chemobrain, including how long the effects last and who is at risk. Other unknowns include how severe chemobrain can be, what cause it, and which chemotherapy agents are most likely to affect cognition. Despite this, preliminary evidence is beginning to confirm what oncology nurses have seen in practice for year.
"I first heard the term chemobrain from my patients, and they describe having memory problems and a hard time concentrating and feeling like their heads a foggy," says Dawn Mack, RN, BSN, clinical ladder III, staff nurse at Loyloa University Health System Cardinal Bernardin Cancer Center in Maywood, Illinois.
A look at the research
Much of the current research on chemobrain has been done with patients with breast cancer.
In the past it was believed that chemotherapy not specifically designed to target the brain did not cross the blood-brain barrier and expose the brain to potential toxic effects. However, in a study published in January 1 issue of Cancer, Japanese researchers found that chemobrain symptoms experienced by some breast cancer patients may be related to structural brain changes secondary to chemotherapy.
Using magnetic resonance imaging (MRI), the researchers found smaller right-prefrontal brain regions and smaller parahippocampal gyri (regions that are associated with memory) in women with breast cancer treated with chemotherapy. Other areas with similar shrinkage, also associated with memory, included the superior and middle-frontal gyri, the cingulate3d gyrus, and the precuneus. The good news is researchers also found a return to normal size three years after chemotherapy, which points to the possibility of cognitive recovery.
Chemobrain also appears to occur in other cancer diagnoses, in addition to breast cancer, in which chemotherapy does not target the brain. Research presented at the 2006 American Society of Clinical Oncology (ASCO) Annual Meeting and published in June 2006 supplement in the 'Journal of Clinical Oncology' stated the majority of study patients treated with chemotherapy and radiation self-reported memory and concentration problems.
"Its mainly breast cancer patients who mention the term," say Mack.
Jayme Levy, RN, BAN, CON, oncology nurse educator at SwedishAmerican Regional Cancer Center in Rockford, Illinois, says she has heart that patients with lymphoma also frequently complain about chemo brain symptoms. She also notes that female patients in general tend to be more vocal about the condition.
"In the last three to five years, we have started to listen and take chemobrain seriously."
"Men don't open up and talk about it," says Leavy, adding that it's the wives and significant others of men who often bring the symptoms of chemobrain to the a attention of healthcare providers.
Researchers also are studying a genetic tie-in to the risk for developing chemobrain. A study published in the September 2003 issue of 'Psychooncology" provided preliminary evidence that people who carry the APOE gene which is associated with Alzheimer's disease, might be more vulnerable to developing chemobrain.
Clouding the Picture
Diagnosis and treatment of chemobrains is difficult because many elements related to cancer and its treatment can imitate or exacerbate the cognitive dysfunction associated with chemo brain. These include stress, other medications, fatigue, radiation therapy, surgery, malnutrition, infection, dehydration, advancing age, menopause, untreated pain, cognitive impairment before the initiation of chemotherapy, depression, and other emotional factors, and the cancer disease process.
Patients with breast cancer often face multiple factors that could contribute to the development of chemobrain symptoms. Many of these women are in midlife and are feeling the effects of the mild cognitive dysfunction normally associated with menopause. In addition, some chemotherapy agents used in the treatment of breast cancer suppress estrogen production and can induce or exacerbate cognitive symptoms as well.
Nurses need to conduct thorough assessments to help identify and address all the reasons that patients with cancer may be having cognitive dysfunction. "You have to look at the whole person and the whole picture," Mack says.
Its also important to rule out cancer metastasis to the brain before making a diagnosis of chemo brain.
Oncology nurses at Loyola and Swedish-American continuously compare their patients' baseline neurological assessments, which are completed before chemotherapy is started, with ongoing assessments.