BY SARAH DIGIULIO
SAN ANTONIO—Complaints about cognitive changes after breast cancer treatment are real and chemotherapy is probably not the only cause of those changes—that was the message from Patricia Ganz, MD, speaking here at the 35th Annual CTRC-AACR San Antonio Breast Cancer Symposium, giving an update on the topic of cognitive changes affecting breast cancer survivors.
In addition to showing research that finds brain abnormalities do present after chemotherapy—according to brain imaging and neuropsychological testing—research also suggests other treatments, too, play a role in the cognitive changes patients report.
“There’s actually been an interest in renaming what people call ‘chemobrain’ to ‘cancer brain’—because many women who actually complain about this after their breast cancer treatment actually didn’t have chemotherapy,” she said. “It can occur if you just have surgery and radiation; it can occur if you have surgery radiation and hormonal therapy; and there’s evidence that more intensively treated patients who have very high-dose therapy are at higher risk.”
Patricia Ganz, MD
Plus, other factors—preexisting genetic factors associated with dementia, anxiety, and depression—also contribute, she said. “In itself, having a cancer diagnosis and having to face the survivorship may lead to anxiety and depression, and may make it difficult for those individuals to concentrate.”
The problems are noticeable to patients and can make it difficult for them to function, she said via email before the meeting, explaining why there needs to be more awareness on the topic. “For women who have this problem, it can be very troublesome,” she said. “Physicians cannot ignore these complaints.”
The first step to management, she said, is looking at the confounding factors like uncontrolled depression, insomnia, pain, and anxiety: “Managing those problems may clear up the complaints.”
And, if patients still report cognitive complaints if those factors are controlled, neuropsychological evaluation should be referred.
The education session on obstacles and risks in survivorship also covered emerging sexual pharmacology for the breast cancer survivor (presented by Michael Krychman, MD), and risk of second primary cancers and other serious late complications issues among survivors (presented by Leslie Bernstein, PhD).
And, a consistent theme was heard from each speaker—more awareness from physicians needs to be paid to survivorship issues. The session itself, scheduled for an hour and 30 minutes, ended 25 minutes late as audience member after audience member approached the microphones with more questions for the speakers—on the topics covered and extrapolating to other survivorship issues, too.
“There certainly are other issues that we admit we were remiss in not covering in this short period of time—but we certainly would enjoy coming back and doing a whole day on survivorship if need be,” said Krychman, in response to an audience member’s inquiry about the emotional ramifications of hair loss associated with breast cancer treatment. “I would challenge the audience to recommend that the time allotted to survivorship is not enough.”
Michael Krychman, MD
Leslie Bernstein, PhD
- Michael Krychman, MD, Executive Director of the Southern California Center for Sexual Health and Survivorship, Medical Director of Sexual Medicine at Hoag Hospital, and a clinical faculty member at the University of Southern California.
- Patricia Ganz, MD, Professor of Health Services in the School of Public Health, Professor of Medicine in the David Geffen School of Medicine at UCLA, and Director of the Division of Cancer Prevention & Control Research at Jonsson Comprehensive Cancer Center.
- Leslie Bernstein, PhD (presenting the slides of Jonine Bernstein, PhD, Attending Epidemiologist at Memorial Sloan-Kettering Cancer Center and principal investigator of the WECARE study, which examines genetic susceptibility and radiation exposure in breast cancer), Professor and Director of Cancer Etiology, Dean for Faculty Affairs, and Member of the Cancer Control and Population Sciences Program at City of Hope Comprehensive Cancer Center.