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 "Patients who complain of cognitive problems may actually suffer
from post-traumatic stress or other substantial psychological
consequences of having cancer, which can be treated,” Dr. Kerstin
Hermelink from CCCLMU University Hospital of Munich, Germany told
Reuters Health by email.
“Physicians should therefore attentively listen to their patients
who complain of cognitive impairment and try to understand their
individual situation to find out what the patient needs,” she added.
The effects of chemotherapy on the brain have been blamed for the
“brain fog” sometimes experienced by women with breast cancer, but
similar symptoms have been reported by breast cancer patients who
haven’t started their chemo yet and even by those whose treatment
didn’t include chemotherapy, Hermelink and colleagues noted in the
Journal of the National Cancer Institute.
To investigate, the researchers studied 150 women who had just been
diagnosed with breast cancer, as well as 56 women without any health
problems.
At several points during the following year, the women completed
neuropsychological tests, as well as evaluations for post-traumatic
stress disorder (PTSD). They also gave their own assessments of
their cognitive function.
About seven months into the study (and about two months after
completion of chemotherapy for the women who received it), there
were no differences in cognitive performance or cognitive changes
between women who received chemotherapy, women whose breast cancer
was not treated with chemotherapy, and the healthy women without
breast cancer.
At the end of one year, however, there was a small decline in the
breast cancer patients compared to the healthy women, but the
decline did not depend on chemotherapy treatment, according to the
research team. Instead, it was linked with PTSD symptoms.
The U.S. Centers for Disease Control and Prevention defines PTSD as
“an intense physical and emotional response to thoughts and
reminders of the event that last for many weeks or months after the
traumatic event.” Symptoms are varied and include - but are not
limited to - flashbacks, nightmares, difficulty sleeping, being
overly alert or easily startled, and having trouble concentrating.
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“I personally was surprised how little cognitive change we
observed,” Hermelink said. “All differences between the two patient
groups and the control group were minimal, even though we used a
large test battery and our study was comparatively well-powered,
with a large sample.”
“Physicians should tell their patients that very subtle cognitive
impairment is not only observed after chemotherapy but also in
patients treated without chemotherapy, and even in patients who have
not yet started any treatment for breast cancer at all,” she said.
“The brain is not a machine that delivers the same level of
performance as long as it is not broken but its function - and in
the long run also its structure - are affected by our actions and
experiences. The diagnosis of a life-threatening illness like breast
cancer comes as a shock to most patients, which may leave traces in
the brain, even if they cope very well.”
Hermelink added, “Research on cognitive impairment associated with
cancer is full of methodological pitfalls that can substantially
distort the results. It is almost impossible for people who do not
work in the field to assess the methodological quality of a study
and thus to find out whether or not the results are valid. Studies
with spectacular findings are relatively easy to publish, even if
they are small and their methods questionable, and of course all
researchers need to publish. Journalists and the public should
therefore be particularly wary of small studies with large and
unambiguous effects.”
SOURCE: http://bit.ly/2qsiAGM Journal of the National Cancer
Institute, online May 3, 2017.
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