Tuesday, September 7, 2010

A Breast Cancer Survivor Asks: Will My Mind Return to Normal? [From Susan]

I was diagnosed with breast cancer over seven years ago and underwent a lumpectomy, chemo and radiation.  Immediately after my first chemo, I experienced severe difficulties remembering things and felt like I was definitely  not on top of my game.  I was immediately placed on disability for my "cognitive deficit"  because I was unable to perform my job as a medical sales representative. I have been seen by many specialists, including a neurologist, neuropsychologist and even had brain scans. I have gone to physical, occupational and cognitive therapy.  Basically, I have suffered loss of a job, a financially secure retirement, loss of respect from family and friends because they have no idea what has happened to me.  And although I have tried to advocate for gaining back some brain cells...I have become very discouraged. Will I ever get better?? -- Susan
 Hello Susan,
You are certainly not alone.  In general, it is believed about 40% of people who have had chemotherapy can have mild to moderate dysfunction with memory and/or attention, well beyond the time of last chemotherapy.   Evidence from research suggests these problems do not get progressively worse, such as might be expected with forms of dementia or Alzheimer's Disease.  However, some research suggests these problems are long lasting over years.
This does not mean you simply have to "live with" the symptoms or their effects
on your quality of life.  Without knowing you, it sounds as though you have had neuropsychological testing to objectively measure your various memory and attention capacities and tried out some treatment approaches.  Our group has been working on a cognitive-behavioral treatment (CBT) for memory and attention problems after chemotherapy.  CBT involves modifying thinking and behaviors to help individuals cope with and self-manage symptoms and their impact on daily lives.  

As you point out, you have had consequences in your occupational, financial, and social aspects of life.  CBT can help foster adaptive responses not only to the memory symptoms themselves but the quality of life impact they have.  The program we are developing and testing is a short term (8-visit) approach that teaches methods to compensate for memory problems (such as keeping an organized schedule, verbal rehearsal) and make adaptive changes to life demands and stress.  We do have some evidence that this CBT approach may help with quality of life and verbal memory performance, but much research remains to prove this.   

I would suggest checking your state's psychological association and ask for psychologists in your area who are well-versed in CBT.  Another national resource is the Association for Behavioral Therapies (www.abct.org).  A psychologist with expertise in CBT may provide you a non-drug common-sense approach to dealing with cognitive effects of chemotherapy.

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