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Decoding chemobrain. Ellis Fischel researchers study the mind's response to cancer treatment.

When June DeWeese had chemotherapy treatment for breast cancer in 1993, she  anticipated some side effects - fatigue, hair loss. What surprised her were the changes to her memory. DeWeese, a librarian and adjunct professor at the University of Missouri, was  accustomed to quickly recalling the information she needed. Suddenly, though, she was forgetting where she placed her keys and grasping for words just out of her reach.

"You know - that flat skilletthing you use to flip a hamburger," DeWeese would say while talking to a friend, not quite able to recall the word "spatula."

During an appointment, she mentioned the issue to her physician, Michael Perry, MD, a former oncologist at Ellis Fischel Cancer Center. He explained that other patients sometimes experience the same phenomenon, often called "chemobrain," and that it wasn't her imagination. For DeWeese, the memory problems were still disconcerting, but Perry's response also was a relief. She knew she wasn't alone.

Since her treatment 16 years ago, health care experts have delved deeper into the topic of chemobrain. No one is quite sure yet what causes chemobrain - maybe chemotherapy drugs, maybe anti-nausea drugs, maybe the way the drugs interact with each other or maybe the psychological stress that the diagnosis causes.

June's memory tips

  • Write lists. "I always alert people when they are starting chemo that it is helpful to start living your life with checklists," Deweese said.

  • Give yourself extra time for tasks you find difficult, such as balancing a checkbook.

  • Ask for help. Tell your family that you may need a helper and that your memory will return, she said.

  • If someone asks you to do something, repeat it back to them.

  • Be extra careful when multitasking. "If I place a tea kettle on the stove and then go grab clothes out of the dryer, I say to myself "unattended cooking" to remind myself.

 


Researchers have answered some questions. Chemobrain is most co mmon among female breast cancer patients, and some studies have shown that up to 35 percent of them are affected. In 2009, Stephanie Reid-Arndt, PhD, associate chair and assistant professor of health psychology at the MU School of Health Professions, and Perry, who formerly served as director of clinical trials at Ellis Fischel, published their research on chemobrain in the journal Psycho-Oncology.

"Before ours, there had not been any studies looking at the effects of chemobrain on cancer patients' quality of life," Reid-Arndt said. "We found that women who were having cognitive difficulties and were concerned about the difficulties also reported that it affected their quality of life."

In their study, Perry and Reid-Arndt followed 33 breast cancer patients, beginning one month after they completed chemotherapy until one year later. At one-month, six-month and 12-month intervals, the study participants completed several neuropsychological tests, such as a memory test in which they memorized a list of unrelated words and were asked to remember the words after the list was taken away.The results showed that most of the participants' cognitive test scores had dropped in the first month after their chemotherapy ended, but after one year, their scores had improved. Participants were also asked questions rating their quality of life. Those with difficulties in memory, concentration and recalling words also indicated the troubles affected them.

"The cognitive difficulties that our patients are showing are not severe deficits, but they can find them frustrating and worrisome," Reid-Arndt said. "Now we know that these are true changes. We can tell them, 'You are not imagining this - these are real difficulties. However, we know that most people experience improvements over time, so there is reason to be hopeful that this will get better. We also know that people learn how to compensate with these weaknesses very well.'"

Their research reflects an overall cultural shift in cancer treatment of caring for patients more holistically, Reid-Arndt said. As screening and treatment for cancer improves, and more lives are saved or extended, health care professionals are looking to improve the lives of cancer survivors.

Reid-Arndt plan to continue their investigation into chemobrain, possibly searching for the cause, ways to prevent or treat it or ways that people compensate.

"The goal is to make sure patients have a good experience with their treatment," said Perry. "We met just the other week to talk about the next steps in researching chemobrain."

DeWeese read the Ellis Fischel study - since her diagnosis, she strives to keep up-to-date on breast cancer news and research. She said that as a cancer survivor, she is grateful that experts are learning about chemobrain. She believes it will give fellow survivors reason for optimism.

"As I told my friend who was recently diagnosed with breast cancer, 'if you know what is happening, it is not quite as scary,'" DeWeese said.

To read the research paper by Perry and Reid-Arndt, please contact MU Health Care's publications office at (573) 882- 3323 or visit http://www3.interscience.wiley.com/journal/122405557/abstract





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