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Death rates for breast cancer have declined over the last several decades, and the United States is home to more than 3.1 million survivors. Yet more than 20 percent of these survivors experience what is colloquially referred to as “chemo brain” or “chemo fog,” a cognitive condition affecting thinking, perception and communication that often goes undiagnosed and untreated. Now, researchers at the Rehabilitation Institute of Chicago (RIC) are proposing a comprehensive set of screening instruments to address cognitive impairments related to this phenomenon.
In a new study published in the journal Current Breast Cancer Reports, Leora Cherney, PhD, a senior research scientist at RIC and professor at the Northwestern University Feinberg School of Medicine, and Diane F. Morean, PhD, a postdoctoral fellow at RIC and Feinberg, outline a standardized approach for screening using online tools that are free and widely available.
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“Physical side effects associated with breast cancer and chemotherapy are treated routinely, but because the research on cognitive issues is relatively new, these issues are not regularly addressed,” Cherney said. “In our paper, we propose systematic screening within the context of standard physical examinations so that doctors can be proactive in identifying and helping patients address the symptoms and possible underlying causes of chemo brain.” In addition to the possibility that chemotherapy is the cause of chemo brain, there are other physical, psychological and social factors that could affect cognition. Symptoms include fatigue, insomnia, distress, depression and anxiety, as well as problems with fulfilling basic needs, workplace issues and interpersonal well-being. The condition has been documented to last for at least 10 years in many patients, although duration of symptoms varies.
Chemo brain can affect patients’ memory, processing speed, word-finding and attention. Morean describes a common symptom, a decline in word-finding ability, as a “tip-of-the-tongue syndrome” that can affect personal and professional encounters. “You know the word you want to use, but you’re unable to retrieve it from your mental dictionary,” Morean said. “We all experience that, but some breast cancer survivors have it far more often, and these cognitive deficits can affect their self-esteem, relationships, ability to return to work and future professional decisions.”
The authors packaged their screening guidelines based on the most well researched and widely understood factors contributing to cognitive impairment in breast cancer survivors. They hope to support the medical community in implementing comprehensive screening for this condition as the standard of care for this population.The online screenings they recommend include FACT-B (well-being with breast cancer), FACT-Cog (cognitive function), FACIT fatigue scale (fatigue), Insomnia Severity Index (insomnia), DASS-42 (depression and anxiety+stress), NCCN distress thermometer (distress+need for social services). All are free and take a total of approximately 30 to 50 minutes to complete. The authors suggest that care providers administer these screenings in waiting rooms or during chemotherapy treatment sessions.
“Our proposed comprehensive screening will empower clinicians to identify cognitive impairments so that patients can be referred for further assessment, support and treatment, as indicated,” said Morean. “For instance, a patient with word-retrieval challenges would be referred to a speech language pathologist, who can devise a personalized therapy regimen.”
Although the six individual screenings Morean and Cherney have recommended are presently conducted sporadically with patients, they are not routinely administered as a package. This comes as no surprise because until very recently doctors and researchers had to focus their energies on simply keeping breast cancer patients alive.
“We’re in the very fortunate position today where more women are surviving breast cancer,” Morean said. “Now, we can look toward the future quality of life for these women and give them the resources to make life as good as it can possibly be.
Beyond identifying chemo brain in patients, Cherney and Morean acknowledge the pressing need that still exists to develop effective treatments for cognitive impairments and communication problems. Currently, they have a treatment study underway to test a home-based, easy-to-use, computerized therapy designed to help with word-finding difficulty and processing speed in women over 65 who have undergone chemotherapy for early-stage breast cancer.
