Online Exclusive Article

Chemotherapy-Related Cognitive Impairment: The Breast Cancer Experience

cognitive impairment, breast neoplasms
ONF 2011, 39(1), E31-E40. DOI: 10.1188/12.ONF.E31-E40

Purpose/Objectives: To provide an in-depth description of the experience of chemotherapy-related cognitive impairment (CRCI) for women with breast cancer and identify related information that women would find useful prior to chemotherapy and at the onset of cognitive changes.

Research Approach: Qualitative, descriptive design.

Setting: Academic breast cancer survivorship center in Kansas City, KS.

Participants: 18 breast cancer survivors within 6-12 months of having completed chemotherapy who self-reported changes in cognitive function.

Methodologic Approach: Data were collected with a demographic questionnaire, semistructured interviews, and a focus group. Qualitative content analysis was performed.

Findings: Study themes were Life With Chemobrain, How I Changed, How I Cope, and How to Teach Me. Participants described difficulty with short-term memory, focusing, word finding, reading, and driving. Issues with fatigue, trouble sleeping, neuropathy, balance, and coordination also were of concern. Coping strategies included writing things down, depending on others, focusing on one task at a time, and giving oneself permission to make mistakes. Participants described exercise and getting enough rest to be helpful and recommended activities to stimulate the mind. Participants wanted information about the potential for CRCI prior to initiating chemotherapy and desired an individualized approach to education. Specific recommendations for education were provided.

Conclusions: The study results provide a framework for understanding the experience of CRCI that can be used to guide development of patient and family education and generate questions for additional research.

Interpretation: Application of the study results will enhance informed consent, validate the experience of CRCI, and contribute to patient satisfaction.

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    Ahles, T. A., Saykin, A. J., Furstenberg, C. T., Cole, B., Mott, L. A., Skalla, K., … Silberfarb, P. M. (2002). Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. Journal of Clinical Oncology, 20, 485-493.
    Beck, S., Dudley, W. N., & Barsevick, A. M. (2005). Pain, sleep disturbance, and fatigue in patients with cancer: Using a mediation model to test a symptom cluster [Online exclusive]. Oncology Nursing Forum, 32, E48-E55. doi:10.1188/05.ONF.E48-E55
    Boykoff, N., Moieni, M., & Subramanian, S. K. (2009). Confronting chemobrain: An in-depth look at survivors' reports of impact on work, social networks, and health care response. Journal of Cancer Survivorship, 3, 223-232. doi:10.1007/s11764-009-0098-x
    Brezden, C. B., Phillips, K. A., Abdolell, M., Bunston, T., & Tannock, I. F. (2000). Cognitive function in breast cancer patients receiving adjuvant chemotherapy. Journal of Clinical Oncology, 18, 2695-2701.
    Downie, F. P., Mar Fan, H. G., Houede-Tchen, N., Yi, Q. L., & Tannock, I. F. (2006). Cognitive function, fatigue, and menopausal symptoms in breast cancer patients receiving adjuvant chemotherapy: Evaluation with patient interview after formal assessment. Psycho-Oncology, 15, 921-930. doi:10.1002/pon.1035
    Elo, S., & Kyngas, H. (2007). The qualitative content analysis process. Journal of Advanced Nursing, 6, 107-115.
    Fitch, M. L., Gray, R. E., Godel, R., & Labrecque, M. (2008). Young women's experiences with breast cancer: An imperative for tailored information and support. Canadian Oncology Nursing Journal, 18, 74-86.
    Jacobs, S. R., Jacobsen, P. B., Booth-Jones, M., Wagner, L., & Anasetti, C. (2007). Evaluation of the functional assessment of cancer therapy cognitive scale with hematopoietic stem cell transplant patients. Journal of Pain and Symptom Management, 33, 13-23. doi:10.1016/j.jpainsymman.2006.06.011
    Jenkins, V., Shilling, V., Deutsch, G., Bloomfield, D., Allan, S., Bishop, H., … Winstanley, J. (2006). A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. British Journal of Cancer, 94, 828-834. doi:10.1038/sj.bjc.6603029
    Mulrooney, T. (2007). The lived experience of cognitive impairment in women treated with chemotherapy for breast cancer (Unpublished doctoral dissertation). University of Utah, Salt Lake City, UT.
    Munir, F., Burrows, J., Yarker, J., Kalawsky, K., & Bains, M. (2010). Women's perceptions of chemotherapy-induced cognitive side effects on work ability: A focus group study. Journal of Clinical Nursing, 19, 1362-1370. doi:10.1111/j.1365-2702.2009.03006.x
    Myers, J. S., Sousa, V. D., & Donovan, H. S. (2010). Predictors of self-reported memory problems in patients with ovarian cancer who have received chemotherapy. Oncology Nursing Forum, 37, 596-603. doi:10.1188/10.ONF.596-603
    Myers, J. S., & Teel, C. (2008). Oncology nurses' awareness of cognitive impairment secondary to chemotherapy. Clinical Journal of Oncology Nursing, 12, 725-729. doi:10.1188/08.CJON.725-729
    Nail, L. M. (2006). Cognitive changes in cancer survivors. American Journal of Nursing, 106(3, Suppl.), 48-54.
    O'Shaughnessy, J. (2003). Chemotherapy-related cognitive dysfunction in breast cancer. Seminars in Oncology Nursing, 19(4, Suppl. 2), 17-24. doi:10.1053/j.soncn.2003.09.002
    Sandelowski, M. (2000). Focus on research methods: Whatever happened to qualitative description? Research in Nursing Health, 23, 334-340. doi:10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G
    Saykin, A. J., Wishart, H. A., Rabin, L. A., Santulli, R. B., Flashman, L. A., West, J. D., … Mamourian, A. C. (2006). Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. Neurology, 67, 834-842. doi:10.1212/01.wnl.0000234032.77541.a2
    Schagen, S. B., van Dam, F. S., Muller, M. J., Boogerd, W., Lindeboom, J., & Bruning, P. F. (1999). Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer, 85, 640-650.
    Thielen, J. (2008). The experience of neurocognitive changes in women undergoing chemotherapy for breast cancer (Unpublished doctoral dissertation). University of Connecticut, Stors, CT.
    Von Ah, D., Harvison, K. W., Monahan, P. O., Moser, L. R., Zhao, Q., Carpenter, J. S., … Unverzagt, F. W. (2009). Cognitive function in breast cancer survivors compared to healthy age- and education-matched women. The Clinical Neuropsychologist, 23, 661-674. doi:10.1080/13854040802541439
    Wagner, L., Sweet, J., Butt, Z., Lai, J., & Cella, D. (2009). Measuring patient self-reported cognitive function: Development of the Functional Assessment of Cancer Therapy-Cognitive Function instrument. Journal of Supportive Oncology, 7, W32-W39.
    Wefel, J. S., Lenzi, R., Theriault, R. L., Davis, R. N., & Meyers, C. A. (2004). The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: Results of a prospective, randomized, longitudinal trial. Cancer, 100, 2292-2299. doi:10.1002/cncr.20272
    Wieneke, M. H., & Dienst, E. R. (1995). Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer. Psycho-Oncology, 4, 61-66. doi:10.1002/pon.2960040108