This section will concentrate on how nurses can help patients endorsing chemobrain, including guidelines coping strategies, and recommendations.
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: