Article date: May 30, 2012 By Stacy Simon Breast cancer survivors – and other cancer survivors, too – have long known that one of the side effects of chemotherapy seems to be a mental cloudiness that interferes with the ability to think clearly, remember details, and pay attention. There is even a nickname, "chemo brain," that some doctors and patients use to refer to this condition. But chemo is not the only thing that can cause problems with thinking and memory for people with cancer. Researchers at the University of Missouri have found evidence that stress also plays a role in cognitive problems in breast cancer patients. The researchers examined 36 women who had undergone surgery for breast cancer, but had not yet received other treatments that could contribute to chemo brain, like chemotherapy or hormone therapy. The women completed tests of their cognitive function and questionnaires about their coping styles and levels of stress. The patients who reported higher symptoms of stress and had ineffective coping strategies, including denial, disengagement, and helplessness, were more likely to experience cognitive problems. Depending on the task, from 14% to 17% of the women had problems with the memory tests. From 11% to 27% had problems with the word and language tests. The study was published in the Journal for Clinical Psychology in Medical Settings.
The role of stress The researchers discussed two theories of the relationship between stress and cognitive functioning. One theory speculates that people have only a limited amount of energy to spend on behaviors requiring self-control, such as making decisions, paying attention, and controlling emotions. According to this theory, using too much energy for one task, such as coping with a cancer diagnosis, leaves less energy for other tasks or behaviors. The other theory focuses on physiological changes in the body in response to stress. It says the body responds to stress by releasing hormones such as cortisol. In the brain, cortisol interferes with the function of neurotransmitters, the chemicals that brain cells use to communicate with each other. Excessive stress hormone levels can make it difficult to think or retrieve long-term memories. Lead researcher Stephanie Reid-Arndt, PhD, ABPP, said often, women receive a breast cancer diagnosis and immediately begin treatment without having much time to emotionally prepare. She said health care providers should identify patients who are experiencing psychological stress and offer effective ways to manage it. Reid-Arndt said, "Teaching patients proactive ways to deal with stress can help them improve their quality of life as well as maintain their cognitive function."
Ways to cope Reid-Arndt said it's also up to women themselves to bring their symptoms to the attention of their health care team. But she said often the women may not know what to think about the cognitive changes they're experiencing and may not realize they should report it. She said there are many different possibilities for women to effectively cope with stress, so each person can be encouraged to find what works best for her. Often she encourages people to think back to other stressful times in their lives to see if they can identify coping strategies that worked previously. Some of the strategies that have worked for her patients include: Regular exercise (including walking, joining a fitness club or group) "Alternative" therapies (including Tai Chi, yoga, mindfulness-based stress reduction) Regularly engaging in enjoyable activities (e.g., time with family, friends) Joining a support group and/or getting involved with others who have also dealt with cancer
Participating in individual psychotherapy The American Cancer Society's online support networks include WhatNext , Cancer Survivors Network, and Circle Of Sharing. WhatNext emphasizes the treatment journey, while Cancer Survivors Network is more focused on emotional support. Circle Of Sharing customizes cancer information that users can share and creates a Personal Health Record. For people with memory problems, the American Cancer Society offers tips that include keeping lists, exercising your brain with puzzles and games, getting physical exercise, eating lots of fruits and vegetables, sleeping and resting, and asking for help from family, friends, and your medical team. Reid-Arndt said, "As a result of advances in screening procedures and in treatment, women diagnosed with breast cancer are living longer than ever before. This has allowed us to turn our attention to the goal of improving quality of life following cancer diagnosis and treatment. In addition to other consequences of treatment that are known to affect quality of life (e.g., fatigue, body image issues, lymphedema), our research has suggested that cognitive deficits also negatively influence quality of life among persons with a history of breast cancer. To help us minimize the occurrence of these difficulties, and to determine possible interventions, more information on potential causes is needed."
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