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chemoabi

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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
 

CHEMOBRAIN

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.

 

Continued!!!

 

 


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chemoabi

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"Nurses need to be really attentive to their assessments and let physicians know as soon as possible of any changes," says Leavy, adding that the number of CT scans and MRI's is increasing over the last year.
 
Other factors associated with cancer and cancer treatment that can impact cognition need to be monitored closely and addressed.  This includes dietary screenings and consultations to ensure good nutritional status and may include extra hydration before and after chemotherapy to negate the potential cognitive effects of dehydration.
 
Stress also can negatively impact cognition, and cancer patients undergoing chemotherapy often have high levels of stress, according to Leavy. 

Treatment - conservative and cutting edge
 
Chemobrain treatment is still in its infancy, but a promising new drug is on the horizon.  Researchers at the University of Rochester's James P. Wilmot Cancer Center have found that women treated for breast cancer who took (Provigil) reported major improvements in memory, concentration, and learning.  Originally licensed to treat narcolepsy, Provigil stimulates the brain only when it is required, promotes wakefulness, and seems to boost brain power without causing the jittery, restless feelings induced by amphetamines.  Research findings were presented to the ASCO meeting in June in Chicago.

Currently, most treatment for chemobrain is conservative and begins with education to help patients and families know what they might encounter and how to best minimize its impact on their lives  One technique that can help patients adjust to chemobrain is recording or journaling about symptoms.
 
This information can be used to evaluate and address such factors as other medication frequently used to treat cancer patients that can affect cognition.  These include antihistamines and anti-anxiety drugs, which are often used in conjunction with chemotherapy infusions.  Narcotics, antiemetics, and antidiarrheals are often prescribed as well.
 
To help patients stay on track with daily activities, patients also are encouraged to minimize multitasking, maintain a daily routine, and use lists and notes as reminder tools.
 
It also is recommended that patients keep essential items, such as keys and checkbooks, in the same place.  Patients should try to keep as active as possible, mentally and physically,without fatiguing themselves.  This may mean letting other people know about the symptoms of chemobrain and asking for help when needed.
 
This article is from my "Nursing Spectrum" magazine.  September 24, 2007 issue and written by Catherine Spader, RN.
 

Is it Chemobrain?

 

Diagnosis and treatment of chemobrain are difficult because many elements related to cancer and its treatment can imitate or exacerbate the cognitive dysfunction associated with chemo brain.  These include

 

...Surgery

...Radiation therapy

...Advanced age

...Infection/fatigue

...Malnutrition

...Dehydration

...Insomnia

...Untreated Pain

...Depression

...Menopause, natural or chemo induced.

...Low blood counts

...Effects of other medications

...Emotional stress

...Effects of the cancer disease process itself.

 

Nicki


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Reply with quote  #3 
My first comment is that no nurse or doctor did a neurological assessment on me to get baselines.  When I talk about chemobrain I get smiles.
 
At least my DH saw the magazine when it was delivered today.  He finially admitted there might be something to this even though I have been telling him that for months.
 
Nicki

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Nicki, I do believe there is a real condition known as chemobrain.  I am 3 years out of treatment and I still have plenty of problems with my memory.  I get scared sometimes, since my Dad had Alzheimers and I think I have the beginning symptoms.  Realistically, I feel it is a combination of chemo after effects and menopause.  I was in perimenopause when I started chemo and full blown menopause by the time I got done.  Sucks!
 
Jan

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Yep, my oncologist talked to me about further neurological damage if I did chemo.  Since I already suffered with Parkinson's Disease and it is a neurological disorder, we decided the benefit did not outweigh the risk.  My fingers are crossed that I made the right decision to not have the chemo.

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Reply with quote  #6 
Oh yeah - Chemo brain, one of the most frustrating things I have had to deal with. No noone did a neurologic or memory assessment on me pre chemo either. My med onc. does talk openly about this though. He knows that it is real and even has noted that people with the most mentally taxing jobs seem to have the most problems, or maybe they are the most disturbed by the changes. Anyway he admits they know so little about this.
I am 10 months post finishing chemo and still struggle. I am much more functional now then I was 6 months ago but still stuggle with memory problems, can't multi task worth a dam, have problems with word recall, and have developed a sort of verbal dyslexia ( I say the correct words but in the wrong order ).
It has become a standing joke in my house and most of the time we all find my verbal errors comical. There are times though when I struggle to the point of being brought to tears of frustration.
It will be interesting to see what further research shows.
Sue
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Thanks Nicki..there sure is alot of information to process about Chemobrain..
I finished chemo six years ago and I still have some of the symptoms..hmmm
You are a real trouper Nicki to help us all out!!


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Reply with quote  #8 
Thank you so much for this Nicki.

I remember reading a study about how chemo alters our brain's white matter.

I know that mine is much worse since this new round of chemo. And I feel like my grandmother who had Alzheimers. I cannot find words sometimes and never remember why I went to the market and what I needed.

As patients live longer after cancer they are going to have to start tackling the long term effects!

Thanks Nurse Nicki!


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I feel the more chemo I have, the worse my memory gets. I no longer make commitments without my planner in my hand.
I feel like an old lady!
chemoabi

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Hello Everyone:  There is alot of stuff in the article to absorb all at once.  One of the things that I'm thinking is important is that this magazine was sent to thousands of nurses.  So its encouraging that they are trying to educate nurses.  It does exist - and we need more health care professionals to understand it.
 
Somethings that caught my eye:
 
...chemo does cross the blood/brain barrier.  So many have told me that it doesn't.
 
...You could have a problem before and as a result of chemo it can become worse.  I have always flip flopped terms.  For example would say that is how the cookie bounces and the ball crumbles.  Since chemo now I find myself saying that is how, ummm Ya know the dough with chocolate chips - cause for one insane moment I cant think of cookies.
 
...Another thing that caught my eye was how the AI's affect chemobrain. 
 
...The thing that scared me was that there might be some that are higher risk.  Predisposed shall we say to Alzheimer's - might be more likely to get chemobrain.
 
I wish I could have shown you the article cause there were pictures of someones brain before and then after chemo and you could see the changes to the brain.  It was a remarkable picture.
 
Jan:  I agree.  I think its a combination of chemo and menopause.  But then I found it interesting that men get it too, they just don't talk about it.
 
Blue:  I cant imagine what chemo would do with someone that has neurological issues.  I'm glad you were able to have a conversation with your doctor.  I always say, once you make a decision, run with and don't look back.  I will keep my fingers crossed for you too - but in the end I think its all a crap shoot.
 
Boo:  word recall and verbal dyslexia describe me perfectly.  Its incredible for example I was trying to talk to my DH about the Colts - but for the life of me, I couldn't remember their name - so I said - Ya know those guys that played football and beat the Bears last year.  My husband sometimes just shakes his head.
 
SoCal:   There is alot of information in this article.  I have read it over several times and keep coming up with new things.  But like I said earlier - at least they are teaching nurses about it.  That's a big start.
 
Gina:  I loved the description of sometimes feeling in a fog.  I feel that way alot. 
 
Flo:  Hahahaha needed a daily planner.  That's a good idea.  Ive decided I'm actually gonna start a little book with daily comments.  Sort of like journalling.  I'm really gonna start keeping track of how often this happens to me each day.
 
So everyone, at least we know we are not crazy.  Anyone have any examples to share with us?
 
Snuck in at work - gotta hit the road. Have a good day.
 
Nicki

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Reply with quote  #11 

I'm not discounting chemobrain because I'm sure it's real but I have a lot of the same symptoms .. not being able to find simple words, losing concentration, stopping in the middle of something because I forget what I'm doing .. and I didn't have chemo.  Some of these can be attributed to stress or Post Traumatic Stress Disorder which many suffer from after a cancer dx.  Some I think can be attributed to Tamoxifen and maybe the other meds I take.  Recent studies now confirm significant increased risk of developing neurological disorders, including cognitive decline, dementia, alzheimer's and parkinsonism for women under 50 who undergo oopherectomy. It's now well known now that estrogen plays an important role in memory retention. Studies show a significant deterioration in performance on working memory tests after four weeks of estrogen suppression. Estrogen influences language skills, mood, attention, and a number of other functions in addition to memory. Estrogen receptors have been found in several areas of the brain and when estrogen presence decreases or disappears, neural chemicals which previously were available in high quantities are no longer largely present causing a decrease in brain activitytake.   I know I posted this before when I was discussing getting my oopherectomy but it will be interesting to see how much worse I get afterwards .. I'm already having cognitive dysfunction!!!  Well I don't want to take over the chemobrain discussion but I wish there were a name for this problem also.  Maybe someone can think of one.  Nicki thank you for starting this thread!

chemoabi

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Charlene:   The article did cover other factors causing cognitive issues - maybe it should cancer treatment brain.  Go back and read the part under "Clouding The Issue."
 
It talks about alot of the issues you are talking about.  An important one they brought  is medications that shut down the production of estrogen - AI's including tamoxifen.  There are multiple factors that can cause chemobrain symptoms. 
 
At least we know, we arnt crazy.  This does exist and people in healthcare are finially paying attention to it.
 
Nicki
 
 
 
 

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Reply with quote  #13 
thanks for the info Nicki

Quote:

...You could have a problem before and as a result of chemo it can become worse.  I have always flip flopped terms.  For example would say that is how the cookie bounces and the ball crumbles.  Since chemo now I find myself saying that is how, ummm Ya know the dough with chocolate chips - cause for one insane moment I cant think of cookies.



this is how I talk
.  I used to stop talking when I couldn't think of a word and get really frustrated.  Now I just start describing what it is I can not identify.  I seem to have a lot of problems with nouns.

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Reply with quote  #14 

I do the same thing too!!!  I just can't come up with the simple word and Susan it does seem to be nouns all the time.  I just stop and look at Karl and he helps me out.  It's not fun.

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Reply with quote  #15 
I'm with you ladies... verrry frustrating to say the least. I am trying to get house in order of the past two years from hell. I keep putting stuff away in "safe" places then forgetting where it is when I need it. Going to the market has become so bad I need to write everything down... ie) where I am going and what I need there. One day it took me over an hour to get to a place that usually takes about 15 minutes... that was scary I was just driving in circles and didn't even realize it. It was bad after chemo... started getting better.... now it's getting worse again with the Tamoxifen. I get really mad at myself when I can't find things or multi task like I used to.
Hugs
CherylG

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