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Susan Krigel, PhD, is a licensed clinical psychologist with the Midwest Cancer Alliance. Her cancer-related career has spanned 10 years, and began when she worked as a Cancer Information Specialist for the National Cancer Institute. In her role at the Midwest Cancer Alliance, she utilizes her clinical and research skills to create and conduct programs with cancer patients across Kansas and western Missouri, focusing on improving the quality of life during survivorship. Programs are delivered both in person and via telemedicine. She also participates in professional development programs for healthcare providers.

Patient Recommendations for Chemobrain

This section will concentrate on how nurses can help patients endorsing chemobrain, including guidelines coping strategies, and recommendations.
PUBLISHED: 8:52 PM, WED DECEMBER 10, 2014
Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
The first two sections of this blog focused on the basics and the science of chemobrain.  This section will concentrate on how nurses can help patients enduring chemobrain, including guidelines, coping strategies, and recommendations.

ARE THERE ANY GUIDELINES REGARDING CHEMOBRAIN?
The NCCN Guidelines on Cognitive Function15 assert that despite increasing evidence of the validity of cancer-related cognitive dysfunction, there is limited evidence regarding treatment.  Health care professionals are urged to validate patient concerns, provide education, and to assess for contributing factors, including medications, depression, anxiety, pain, fatigue, substance abuse, and sleep disturbance. Imaging studies are only recommended in specific situations.  

HOW CAN I HELP MY PATIENTS WHO ARE DEALING WITH CHEMOBRAIN?
As mentioned in an earlier blog, although the majority of patients eventually return to pre-treatment baseline, a subset report significant impairment in quality of life, independence, and self-confidence16. One of the most important things you can do is to provide emotional support by listening to the patient’s concerns and validating the existence of chemobrain16. It is common for families, co-workers, and friends (and sometimes even health care professionals) to not understand that the emotional, physical, or cognitive effects of cancer treatment may linger after treatment has ended.

WHAT TREATMENTS ARE AVAILABLE?
In a review of treatments for chemobrain, Von Ah et al.17 categorized treatment into pharmacologic and non-pharmacologic interventions.  The review documented that so far there is no strong evidence supporting the effectiveness of medications for chemobrain.  Trials have explored the use of psychostimulants and drugs used to treat dementia, but results have been mixed and further research is needed.  Erythropoietin stimulating agents have also been tested, but due to concerns with adverse effects, they are not recommended for this purpose.

Thankfully there is a wide variety of non-pharmacologic strategies available, ranging from exercise, mindfulness, social support, and organizational strategies. Perhaps the largest body of evidence supports exercise to boost cognitive function18, although much of the research in this area has been conducted with non-cancer populations.  However, there are several studies with cancer patients that have documented the effectiveness of exercise, including Qigong19, Tai Chi20, physical fitness21, and resistance training22 to alleviate the symptoms of chemobrain.  The review by Von Ah et al.17 documented that structured cognitive training programs, addressing memory, attention, and processing speed have been promising, but the programs are not generally available outside of clinical trials. One final note:  A recent study found that loneliness increases the risk of cognitive problems among breast cancer survivors23. Encouraging increased socialization for those at risk of being lonely may be helpful.

WHAT ABOUT THE EFFECTIVENESS OF COMPUTERIZED TRAINING PROGRAMS?
Despite the ads touting the effectiveness of their own programs, currently there is no strong evidence that computerized cognitive training produces significant, lasting cognitive benefits.

WHAT OTHER SUGGESTIONS CAN I PROVIDE TO PATIENTS?
In my practice with cancer patients, I’ve provided the following list to patients:
  1. EXERCISE!! Walk, do yoga, strength training, or any type of movement that you enjoy.
  2. Get organized!
    1. Establish and follow routines: The more automatic a routine is, the less likely something will be forgotten.
    2. Prioritize activities: If someone is very busy, focusing on the more important activities and letting the others go by the wayside will help minimize forgetfulness.
    3. Write it down: Be meticulous in keeping a calendar and a “To Do” list.
    4. Cancer Care has a wonderful list of organizational strategies here
  3. Take a mindful approach to your challenges:  Acknowledge that you are different now, and accept your imperfections. 
  4. Focus on your strengths.
  5. Use humor
  6. Enlist social support:  Have family and friends share the responsibilities for tasks, such as organizing large holiday dinners.
  7. Be social! Get out among people as much as possible.
  8. Use GPS when driving.
  9. If tolerated, use coffee in moderation to boost focus.
  10. Do mind-challenging activities, such as Sudoku and crossword puzzles.
  11. Use SQ3R (Survey, Question, Read, Recite, Review) if needing to approach academic material.

References
  1. National Comprehensive Cancer Network. Cognitive Function (Version 2.2014). http://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. Accessed December 8, 2014.
  2. Myers JS: Cancer- and chemotherapy-related cognitive changes:  The patient experience. Sem Oncol Nursing. 2013;29:300-307.
  3. Von Ah D, Storey S, Jansen CE, et al: Coping strategies and interventions for cognitive changes in patients with cancer. Sem Oncol Nursing. 2013;29:288-299.
  4. Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition and the aging brain. J App Physiol. 2006;101:1237-1242.
  5. Oh B, Butow PN, Mullan BA, et al. Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients:  a randomized controlled trial. Support Care Cancer. 2011;20:1235-1242.
  6. Reid-Arndt SA, Matsuda S, Cox CR. Tai chi effects on neuropsychological, emotional, and physical functioning: a pilot study. Cont Ther Clin Practice. 2011;18:26-30.
  7. Korstjens I, Mesters I, van der Peet E, et al. Quality of life of cancer survivors after physical and psychosocial rehabilitation. Eur J Cancer Prev. 2006;15:541-547.
  8. Baumann FT, Drosselmeyer N, Leskaroski A, et al. 12-Week resistance training with breast cancer patients during chemotherapy:  effects on cognitive abilities.  Breast Care. 2011;6:142-143.
  9. Jamerka LM, Peng J, Bornstein R, et al. Cognitive problems among breast cancer survivors: loneliness enhances risk. Psycho-Oncol. 2014;23:1356-1364.


Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
More from Susan Krigel, PhD
This second installment of this blog on loneliness focuses on how loneliness may compromise health and can be combatted against.
PUBLISHED: Fri March 24 2017
Exploring loneliness and its effect on health. Part 1 of 2.
PUBLISHED: Wed February 22 2017
The first section of this blog provided statistics on suicide and warning signs,
PUBLISHED: Thu August 13 2015
Have you encountered patients who have voiced the wish to kill themselves?
PUBLISHED: Wed July 15 2015
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