Saturday, 31 March 2018

Weekly Discussion Summary ~ Chemo brain 4

"Chemo-brain is real."

Our weekly discussion explored the phenomena known as chemo-brain - the thinking, attention and memory problems that so many of us experience during and after cancer treatments.

Chemo-brain, as our group discovered, is a somewhat misleading term because even those of us who had not had chemotherapy described experiencing impairments in our thinking abilities.

What then do we mean by "chemo-brain"?

Our discussion, which included women with primary and secondary breast cancer, described the following symptoms: forgetfulness, lapses in attention and poor concentration; many shared that we experienced significant difficulties in relation to thinking and retaining information, particularly our short-term memory and 'working memory' by which we mean holding one task or piece of information in our mind while completing another task, and, with our 'executive function' which is 'the CEO of the brain' because it involves those skills which allow us to set goals, plan and get things done.

Sometimes our errors were small, and we could laugh them off, such as walking into a room and forgetting why we were there, or getting our partner's name wrong! But more often, our thinking problems feel much more significant and undermine our confidence and ability to function in our everyday lives, for instance at work and in our relationships with our friends and families. Worse still, those around us can get irritated and impatient, finding us poor company and less organised than we used to be.

Naz explained that chemo-brain is real and that research has repeatedly shown evidence for it - both 'self-reported measures' of cognitive decline that reflect our perception of our cognitive functioning and 'objective measures' of cognitive function, looking at behavioural performance on tasks that measure cognitive function, and 'neuroimaging measures' that reflect activity in the brain.

Imaging of the brain (neuroimaging) has shown that chemo-brain exists right after diagnosis and before treatment begins - individuals with breast cancer showed more brain activity in the brain structures that are involved in executive function and working memory, indicating what Naz called 'compensatory efforts' i.e. the brain is compensating. Interestingly, the behavioural performance of individuals with breast cancer was the same as non-affected individuals. This means that individuals with breast cancer had to use MORE resource to manage the same behavioural outcomes as non-affected individuals. Naz told us she is working to be able to understand this deficit in more detail.

Why does chemo-brain occur?

The trauma of receiving a life threatening illness diagnosis impacts on our psychological and social well-being and dealing with it requires mental as well as physical resoures. Our working memory begins to accumulate information and worries which supercede everything else. We can quickly become overwhelmed and our executive function becomes sluggish and inevitably prioritises cancer related information. It's not surprising that we experience problems holding other information in our working memory.

Fatigue is a natural consequence of chemo-brain as our bodies and our minds need to work harder, so much harder, just to do the ordinary, every day activities which we previously took for granted - it feels like we are swimming against the tide, using all our energy to stay in one place.

Chemo-brain, Naz told us, is exaggerated considerably by chemotherapy and radiotherapy. Hormonal treatments, lack of oestrogen and sudden menopausal symptoms also contribute, accumulating these effects on our ability to think, remember, and carry out tasks.

Naz explained that chemo-brain can increase our vulnerability to anxiety and depression. As a group, we described how our forgetfulness and lapses in ability severely undermined our self-esteem, self-confidence (at work), and our relationships.

How long can chemo-brain last for?

Naz told us that chemo-brain effects lessen over time, but this is highly dependent upon individual differences. Many of us felt that our chemo-brain has worsened in some aspects of our thinking, memory and attention.

What can we do to cope with chemo-brain?

* It’s easier said than done, but Naz said there is evidence to show that challenging our brains in systematic and adaptive ways can help improve processing efficiency and this has implications for well-being and resilience.
* Sleep has enormous effects on consolidation and the formation of new neural connections that can help maintain healthy cognitive functioning (but as we know, many of us struggle to sleep).
* Controversially, our food has an impact too, and some of us reported drinking water helped us to feel clearer.

As a group, we had lots of suggestions about ways to cope including: tackle small tasks immediately; write things down straight away; use notes, lists, a diary, post-its, phone reminders and alarms. Self-compassion and managing our stress can also help us to cope with the effects of chemo-brain. Our experiences highlight how little support and understanding is available to us and what we need most of all is for 'chemo-brain' and it's consequences to be taken seriously as well as interventions to help.

If you are a woman living in the UK with a breast cancer diagnosis and you would like to join our private group, please message via our facebook page


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