Sunday, April 29, 2007

Lingering Cognitive Effects of Chemotherapy

Something that breast cancer survivors have been reporting for years is finally being taken seriously. In The New York Times on Sunday, April 29th, 2007, there is a front page article titled, "Lingering Fog of Chemotherapy Is No Longer Ignored as Illusion". The author of this article, Jane Gross, states that due to a "flurry of research" it is now widely acknowledged that "patients with cognitive symptoms are not imagining things" and that some oncologists are now "rushing to offer remedies including stimulants commonly used for attention-deficit disorder and acupuncture". According to Ms. Gross, about 15 % of breast cancer survivors treated with chemotherapy, continue to experience cognitive side effects years after the treatment has ended, and it is this group of women who have been the focus of the cognitive research to date.

How do we know that the percentage of women experiencing long-term cognitive deficits isn't much higher? The same factors that kept doctors from acknowledging the possibility of long term cognitive deficits as a result of chemotherapy, could now be responsible for a continuing underestimation of not only how many women are being affected, but also the nature and the extent of the cognitive changes being experienced.

Before we start rushing to give women more drugs to try to treat these cognitive side effects, it seems that the sensible, logical thing to do is to conduct well designed research studies that include pre-treatment and post-treatment cognitive measures that are sensitive enough to pick up even subtle changes, and that include groups of women who have been through different treatment regimens for differing lengths of time. We also need studies that can help us to discriminate between the effects of the abrupt onset of menopause, depression and anxiety from the effects of the various chemotherapy drugs that are being administered.

Ms. Gross's article is helping to call attention to this ongoing problem, and hopefully fewer patients will receive patronizing responses from their oncologists when they raise or report these issues. Impaired short term memory, increased distractibility and loss of the ability to multitask are things that have been anecdotally reported by many women for many years. Large scale longitudinal research studies that are funded by our government and not just by drug companies, are what we urgently need in order to help all cancer patients make better informed decisions about which treatment options to choose.

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