Jennifer Cargile on Managing Cancer-Related Cognitive Impairment

According to Jennifer Cargile, MEd, CCC-SLP, a speech language pathologist with City of Hope Atlanta, it is important to find ways to help patients with cancer-related cognitive impairment recognize and manage their symptoms so that they can continue with their day-to-day routine.

In an interview with Oncology Nursing News®, Cargile shared some experiences helping patients. The first example she shared was about a patient who realized he was struggling to pay his bills.

“I always ask, ‘Why are you here? What brought you here?’” she told Oncology Nursing News. “He [said], ‘Well, it all started with a bill… I've been paying bills for 45 years.’ That's it. OK. [He tells me,] ‘Successfully. I have an Excel spreadsheet. I check off every month if I have paid the bill.’ I am thinking: ‘Where are we going with this?’”

The patient explained that his wife worked for an online retailer in a downstairs office. One day, she came upstairs and complained that the internet was off while she was in the middle of her shift. Cargile’s patient recalled thinking that the internet company would need to reimburse them with a free month of internet because it was a beautiful day and all of their neighbors said their internet was working. He thought that it was clear that the internet provider had a problem.

The patient called the company and said “Listen, my wife is in the middle of her shift, and she has to be working.” The internet company responded by saying, “Sorry, you have not paid your bill in 3 months.”

“'We have not received payment on your bill in 3 months, we shut you off,' they told him. He said 'OK, can you take a credit card number? Here you go. Here's my credit card number and if my wife calls, this was an outage. This was an outage.'"

He immediately called his doctor to say that something was wrong. “I have never, ever in my life missed a bill,” he later told Cargile. When Cargile asked him if he had checked with his Excel spreadsheet, he said that he had been checking off the payments as completed but had not written down a confirmation number in over 3 months.

“She was right—in the last 3 months, I had nothing on the spreadsheet,” he told Cargile. “But, in my mind, I had already paid it.”

“We worked with him on strategies to improve this,” Cargile told Oncology Nursing News. “We [created] a completely different system for bills that is much more simple and not as complex as the Excel spreadsheet. After a couple months, he was like, 'OK, this is great. I feel confident enough. I'm good to go.'"

Cargile also shared a story of a patient who was struggling to remember the prices that she charged at her car wash.

“I had this patient who lives in a very Metro downtown, a big, large-city location, and she owned her own carwash detail business,” she said. “She had owned it for 20 years. She came in and she [said], ‘I'm forgetting what prices we charge for our different services.’”

She was concerned that if her customers were aware of the situation, they would use it to take advantage of her. Cargile came up with a plan to help.

“I called her son,” Cargile said. “He worked in the detail business. I said, ‘Send me a list of every service you have and the price.’ He goes, ‘Yeah, I got it.’”

Cargile helped the patient create laminated cards with all the specials and their corresponding prices. A friend of hers sewed a system with pockets for the cards that could be attached to the side of the building. When customer drive up and say “I want Special A” they received a “Special A” laminated card. The card says, “Special A; $40.”

“When they hand it to her, she knows she needs $40 from the customer, she puts it to the side and then she is able to balance her register every night because the cards are right there and then she makes sure that everything balances up,” Cargile explained.

“These were some crutches that I helped provide patient so that way they can continue to be successful and then nobody knows [they are experiencing cognitive impairment],” she concluded.