“Thinking and Memory Changes”
speaker for this conference was Patricia A. Ganz, M.D. and our
moderator was Marisa Weiss, M.D.
A. Ganz, M.D. is a medical oncologist and serves as Director of the
Division of Cancer Prevention and Control Research at the Jonsson
Comprehensive Cancer Center at UCLA Medical School. During the past 20
years, Dr. Ganz has focused on understanding how people adjust to the
diagnosis of breast cancer, including its effects on their physical,
emotional, social, and sexual well-being. She developed a way to predict
which people are likely to develop significant psychological distress in
the year following their diagnosis, and has completed several studies
examining the quality of life in breast cancer survivors. In July 1999,
Dr. Ganz was awarded an American Cancer Society Clinical Research
Professorship and honored with the Komen Foundation Professor of
Survivorship Award. Dr. Ganz is also a member of the breastcancer.org Professional
Weiss, M.D. is Founder and President of breastcancer.org. Dr. Weiss is a
radiation oncologist specializing in breast cancer, and serves as Director
of Breast Radiation Oncology at Lankenau Hospital in Wynnewood, Pa. She is
the author of Living Beyond Breast Cancer, and the founder of a national
nonprofit organization of the same name. Dr. Weiss received the 2003
Professor of Survivorship Award from the Susan G. Komen Breast Cancer
Foundation and was selected as Doctor of the Year 2005 by Philadelphia
Magazine. From 1998 to 2004, Dr. Weiss co-produced and appeared on the NBC
Today Show’s Special Breast Cancer Series. Dr. Weiss is also a member of
the breastcancer.org Professional
Welcome! Thanks for joining our special breastcancer.org Ask-the-Expert
Online Conference: Thinking and Memory Challenges. As much as possible,
we’ll answer those questions that cover the topics most of you are
interested in. We’ll be answering only questions that relate to this
month’s topic from participants in this live, online conference, as well
as questions from members of the breastcancer.org community who couldn’t
join us tonight. And now, let’s go to our first question.
I was recently diagnosed with breast cancer (multi-focal DCIS) and have
had a bilateral mastectomy. No chemo or radiation is needed. Lack of
cognitive speed and efficiency has been an issue for the last year or so.
Can it be related to the cancer itself and not the effects of chemo,
radiation or any medication? I am 47 and perimenopausal. What can you
suggest I do to address this issue?
Ganz: This question is a very good one because people in midlife who are
perimenopausal have disruption in their sleep and as a result have
difficulty concentrating. It is unlikely that your complaints are related
to the cancer itself even though we know that the cancer was developing
before you were diagnosed.
Weiss: Women are very finely tuned animals and we are very sensitive to
small as well as big changes in our lives. When things get us rattled or
upset or a little disoriented, our ability to think clearly tends to be
affected. We are often in charge of coordinating so many things in our
lives. When you are juggling six balls at the same time and someone throws
you a seventh ball to juggle, it can be unnerving. It throws off a lot of
sensitive functions that you expect yourself to do well, including
thinking clearly and remembering well.
How long can a patient expect to experience memory issues? I am seven
months out from eight rounds of chemo and then radiation, and I still have
terrible short-term memory, which seems worse than if it were long-term.
Ganz: The experience of memory loss associated with cancer treatments
usually occurs at the time of treatment and in a small number of women
persists beyond that time. Some things that may contribute to short term
memory difficulties are loss of energy, difficulty sleeping, and anxiety
related to fear of the cancer coming back. In addition, some of the
research we are doing suggests that there may be a relationship between
the cancer treatment and changes in hormones. The changes in hormones
could be [due to] going through menopause
as a result of the treatment or from the endocrine treatments we give as
part of therapy. In terms of recovery, most women will have slow but
steady improvement in memory especially if they pace themselves and try to
decrease activities that may make it more difficult to concentrate.
Weiss: I remember taking care of someone who was exactly in your
situation. She could barely string a sentence together without faltering.
During treatment she had stopped work, lost her confidence, and began to
doubt herself particularly when doing everyday normal things including
talking. I just saw her two years later this past week and she was
chatting up a storm. Things had gotten back to normal for her. She had put
in place a number of regular rituals and routines back into her life, and
she found new ways to reduce her anxiety about how she was
“performing” at home, at work, and in her community. It was
great to see her bounce back like that, though it did take a lot of time
and effort as Dr. Ganz has suggested.
What if you took hormone replacement therapy before your diagnosis? Would
that affect whether or not you had memory problems during breast cancer
Ganz: As far as I am aware there is no impact of prior hormonal
replacement therapy on the post-treatment complaints. However, it is now
known from the Women’s Health Initiative hormone therapy trials that women
who were randomly assigned to estrogen and progesterone or estrogen alone
had a significant decline in memory functions compared to women who were
given a placebo. It used to be thought that hormone replacement was good
in terms of preventing Alzheimer’s or memory loss, but that is not the
case. So getting off hormones as a result of breast cancer may be
Weiss: Whenever you make a change in your life, like going between
medicines or stopping medicines, you’re likely to feel a few bumps in the
road. It gets back to my point that we as women do so many things at the
same time and not only do people around us expect but we also expect from
ourselves that all of our responsibilities will be balanced and done
properly and on time, just like we used to. All these expectations can
feel burdensome when you are dealing with a breast cancer diagnosis and
all the treatments that may be involved. It is important to adjust your
expectations when you are facing this big challenge in your life. Give
yourself some wiggle room.
I am one year post-chemo, radiation and a hysterectomy. I have noticed
some improvement with memory. Is there anything I can do to help improve
it further? I am 40 years old and this is very frustrating. Thanks for
Ganz: There are issues related to memory loss as we all age and there are
actually some interesting books that are written describing how to keep
your memory in shape. They’re focused primarily on older people, but
keeping mentally active, reading, doing puzzles, and being intellectually
engaged in some activity will exercise your brain just like you would
exercise your body.
How long do chemo brain and memory lapse last? I’m still struggling,
especially when tired, and it’s been two years since my chemo sessions.
Ganz: You’re asking a very good question about two interrelated problems
that many women will experience after breast cancer. The first is problems
with memory and concentration. The second is fatigue. Fatigue actually
occurs in about a third of all women after breast cancer treatment and
does not seem to be related to a specific cancer treatment. That is to
say, some women who just have surgery and no chemotherapy may feel
fatigued. In addition, a smaller number of women complain of memory
concentration problems. We have a difficult time knowing for sure what the
number is but it’s probably in the range of 15 percent, which is much
lower than initially thought. It’s also becoming evident that women who
complain of difficulties with their memories and concentration are not
necessarily women who perform poorly on standardized memory tests that a
neuropsychologist would administer. What I’m trying to say is the
perception or sense that one is having trouble with one’s memory may not
always lead to poor performance on a test, and sometimes it’s anxiety,
depression, difficulty with sleep, and fatigue that are making one have
difficulty concentrating. Therefore, it’s important for us to treat
anxiety, depression and difficulty sleeping before assuming that someone
has serious difficulty with concentrating.
Weiss: This point that Dr. Ganz is making is critically important.
Basically, all of the anxiety, depression and the other conditions that
she described actively interfere with your memory and your thinking
ability as well as your capacity to learn new things. And that’s why it is
so important to address those concerns, to free your mind up to do the
work of thinking and remembering. Your ability to perform “executive
functioning” requires coordination of many different functions of the
brain and anxiety in particular can completely undermine your ability to
coordinate all the different things you ask your mind to do throughout
I call my memory lapses chemo brain, but I’ve been told this can also be a
symptom of menopause. Is this something that may get better as the
symptoms of menopause abate?
Ganz: You’re raising a very interesting question and many women with
breast cancer have two colliding situations. One is the onset of
menopause, which may be premature and at a time in life when you’re not
expecting it. The second is breast cancer, which is very distressing in
terms of the seriousness of the diagnosis as well as the complexity and
toxicity of its treatment. Many women going through menopause normally
(which would actually gradually occur over a 10-year period of time from
the mid-to-late 40s into the mid-to-late 50s) notice changes in their
memory, and this may be related to difficulties sleeping. They may awaken
at night with sweats and hot flashes.
addition, there is well-documented evidence that estrogen plays an
important role in verbal word fluency, which is the medical phrase to
indicate remembering words, remembering names. The only single deficit
that lowered levels of estrogen is related to is the ability to remember
words and names. Many women, such as myself, who have transitioned to
menopause will have difficulty remembering the specific names of people or
places and it may take a painfully long time to retrieve a word or name.
When a woman has chemotherapy and all of a sudden she’s 45 and
menstruating, and within two months has stopped, she has condensed what
might have been a 10-year experience to a few months. Suddenly, the body
has to adjust to a much lower level of estrogen. This may lead to very
serious night sweats, hot flashes, changes in mood, and memory problems
from not sleeping and the sudden changes in her hormone levels. So in
addition to the chemotherapy that she’s receiving, which may possibly
contribute to the syndrome that’s called chemo
brain, she also has the sudden onset of a chemical menopause which is
very severe in its symptoms and side effects. So many women who ultimately
complained to their doctor a year after the treatment that they couldn’t
think clearly, that they were having difficulty remembering names and
doing tasks, may have this experience because of the onset of menopause,
but it could also be contributed to by the treatment. This is the real
challenge we have: to try and figure out what’s going on and whether this
is just menopause or being contributed to by the cancer treatment.
Should any patient consider not taking Arimidex any more even though the
five-year period is not complete just to avoid or try to diminish the
medication side effects? Are there any new studies that may refer to
shortening the time period of five years and have good results?
Ganz: This is an interesting question, but it’s really not on target for
our discussion tonight, which is about changes in memory with cancer
Weiss: We will provide links and content within breastcancer.org to help
you answer this question.
note: There are no data yet that can tell us whether taking Arimidex for
less than five years has the same protective benefit as taking it for five
years, although this is currently being studied. If you find that it’s
difficult to manage the side
effects of hormonal therapy, ask your doctor about management
strategies, or possibly switching
to another type of hormonal therapy.
Ganz: One of the questions is whether Arimidex
has any association with memory. In my clinical experience I have not seen
women report memory change with Arimidex, but that does not mean it is not
an issue. I do think it is an important question and I will be starting a
study in the near future that will hopefully begin to answer this
Is there a medication for this memory problem?
Ganz: At this point in time, there is not a specific medication that I
would recommend, although some studies are being conducted with the drug
Provigil (chemical name: modafinil). This is a drug that is approved for
the treatment of narcolepsy, a condition where people have trouble staying
awake. It makes them more alert. Clinically, this is being tested for
individuals who have difficulty thinking clearly after treatment. I’ve
seen some patients who have used it for treatment of fatigue and memory
and concentration problems. At this point in time, this is not an
FDA-approved usage for this drug.
Weiss: If you are having persistent difficulty with your memory and being
able to think clearly, you may need to be evaluated by a neurologist (an
expert on the nervous system including function of the brain). These
doctors have a lot of experience helping people improve their memory with
lifestyle changes, mind exercises, and even medication. An experienced
neurologist may have additional ideas.
note: If you have persistent problems with memory loss and clear thinking,
consult a neurologist. Special tests can be done to better understand the
nature of your situation, called neuropsychological testing. A medication
used for memory issues for patients with Alzheimer’s disease, Aricept
(chemical name: donepezil HCI), may also be considered for patients with
other illnesses—but only with careful expert evaluation and management.
Ganz: A neuropsychological exam may help in making recommendations because
[neurologists] are used to being with people with brain injuries.
Twelve months after chemo finished, and I still can’t concentrate for more
than four hours at a time. I do puzzles, sudoku, and crosswords to aid
functioning. What else can I do?
Ganz: It sounds like you’re already doing a lot of exercise for your
brain, which is helpful but you may need to look at your overall situation
and make sure that you’re not tired or having difficulty sleeping. If you
need to take a nap or a break from work, that’s very important. Even
people who have not had cancer treatment may have difficulty concentrating
for more than four hours at a time. So be kind to yourself and make sure
that you’re taking care of your whole body, not just your brain.
Weiss: Be careful about drinking too much coffee to help overcome fatigue
during the day because in many individuals caffeine can stick around for a
long time into the night, and interfere with your ability to get a good
How can I better concentrate my full attention on what someone is saying?
Since chemotherapy, I’ve really had a difficult time focusing.
Ganz: It sounds like you may be having some stress related to your
treatment and your cancer experience. Many patients tell us that one of
the most stressful times is actually when they finish their treatment,
more than when they’re on it. All of the sudden they feel out of control,
nothing’s protecting them from the cancer, and they may not be seeing
their physician as frequently as they were. Having this extra stress may
be a distraction and prevent you from concentrating when someone is
talking to you. You may also feel that you have different priorities after
cancer treatment and that inconsequential things that someone may be
saying to you may not be as important. It’s also clear that if you’re
tired, if you haven’t slept well, or if you’re not eating and exercising
properly, that these may affect your ability to concentrate.
Weiss: One important communication tip to help you talk to the people you
want to talk to and avoid or minimize the amount of time listening to
people who might bring you down is through communication like email,
letters, voicemail. With this type of communication, you can respond at
your own convenience instead of immediately. Avoid the telephone or get
call waiting. Many people are calling you to talk and offer you help. If
you can avoid disruptions of work you might be doing and deal with the
phone calls and emails during a break, you can save some energy. One place
people go to connect with each other for support and to build energy and a
sense of community with others who share their concerns is the
boards and chat rooms.
Is it better to confess to a boss that you are experiencing chemo brain
(cognitive loss) or just try to cope and cover it up (make detailed lists,
etc.)? Will an employer see this as a sign of weakness?
Ganz: This is a very good question because discrimination in employment is
still a problem for patients with cancer, unfortunately. I’m not sure
where you are living. If it’s the US you have the Americans With
Disabilities Act which is supposedly available to protect patients with a
cancer history and diagnosis against discrimination at work and
accommodations are supposed to be made for disabilities or limitations
that a person may have as a result of their illness. The particular kinds
of cases either where someone is fatigued or has trouble concentrating are
very difficult sometimes for the employee to get accommodation for. I’m
helping some lawyers who are defending women in the situation, and not all
employers are sympathetic to the situation. I think it really depends on
what kind of an organization you’re working in and how comfortable you
feel. If your employer knows you had cancer and may have some needs for
modification to your schedule or activities, then you should be direct and
speak to the Human Resources supervisor in the organization. If you’re in
a small office or employed by a small business, this may be more
difficult. One of the challenges is that women who have survived breast
cancer treatment often look well and people think that they should be
doing everything that they did before diagnosis. But we know that there
may be many subtle physical and emotional scars that may limit the ability
to do work at the same level that it was performed before the cancer
Weiss: Let your doctor be your advocate. A carefully written note from
your doctor to your employer, with your permission, can be very effective.
A letter could help you cut back your hours for a finite period of time
with a plan for reevaluation. Shifting some of the communications from
your own shoulders over to your doctor can be a relief to you, and your
boss might be more responsive to a more “authoritative”
correspondence. An offer to your boss to talk to your doctor if he/she has
any additional questions also works well. In my professional experience,
many of my patients make this offer to their boss and nearly no boss ever
picks up the phone to question the recommendations I’ve made. Ultimately,
it eases your worries about your work performance, so this is a good
What are your feelings on sleep medication?
Ganz: Sleep medication may be very helpful to some women, particularly if
you’re having difficulty sleeping on an occasional basis because of pain
after surgery or if you’re having difficulty with anxiety or stress. Long
term sleep medication may not be the best solution and it may be best to
obtain a better understanding of why you’re not sleeping well. One of my
colleagues here at UCLA will be starting a study to test whether tai chi
may be helpful in sleep management for women after breast cancer. Part of
the thought here is that this kind of exercise has both a physical and a
relaxation component to it. There are many aspects to sleep disturbance,
which may be related to lack of physical exercise during the day, as well
as the inability to relax. So we need to understand what’s really causing
the sleep disturbance. Is the individual anxious and can’t fall asleep, or
are they being awakened by hot flashes, which is a physiological problem?
Or if the problem is sleeping and napping during the day due to fatigue,
then they don’t feel tired at the time they should be sleeping at night.
All of these issues have to be reviewed very carefully and if one can
identify the cause of the sleeplessness it’s far better to treat that
condition rather than use medication. Again, medications are fine for
short term problems that disrupt sleep such as pain and anxiety. But if
there is a chronic ongoing sleep problem, then it’s important to try and
find out what’s causing it.
Is there any research demonstrating that physical exercise improves
Ganz: At this point in time, I’m not aware of physical exercise improving
short-term memory. If someone is exercising regularly, one is more likely
to sleep better, and that may help someone’s memory due to better sleep.
Weiss: For people who are having difficulty sleeping, avoid alcohol. While
it may help you go to sleep initially, you’re more likely to wake up
during the evening. Also, alcohol can interfere with your ability to think
and remember well.
My mother-in-law took tamoxifen for five years after breast cancer and
then developed Alzheimer’s disease, which progressed rapidly. Is it
possible there is a link between tamoxifen and dementia? She did not
receive chemotherapy, just radiation.
Ganz: This is an excellent question, Holly, and one that I’m very
interested in. In a limited study that we did of women who’d been treated
for breast cancer five to six years earlier, we did neuropsychological
testing and PET scans of the brain to see how the brain functioned in
these women. We saw worse brain function in those who had chemotherapy and
tamoxifen in comparison to those who had no chemotherapy or chemotherapy
only. We did not have a group of women who had tamoxifen alone, which
would be comparable to your mother’s situation. However, as I mentioned
earlier, the Women’s Health Initiative study comparing estrogen and
progesterone or estrogen alone to placebo demonstrated a decline in
cognitive function. Tamoxifen is a mixed estrogen and anti-estrogen drug
and therefore could possibly have estrogen-like effects on the brain that
could be similar to what was seen in the Women’s Health Initiative study.
I’m hoping that the study that I’ll be conducting over the next five years
will allow us to examine if tamoxifen has such an effect.
Weiss: Dr. Ganz has been a leader in research on quality of life for women
who’ve had breast cancer. Her championship has made remarkable advances in
our understanding of all of these issues that you are sharing with us this
evening. It’s terrific that you are conducting this important study. Thank
Which kinds of chemotherapy are more likely to cause cognitive difficulty?
Ganz: At this point in time, we really have no certainty about whether it
is chemotherapy or chemotherapy in addition to menopause or other factors
that lead to this cognitive difficulty that women complain of. We have no
specific association with a particular chemotherapy regimen or type of
Weiss: The studies that have been done so far have been too small to
determine if a particular treatment is associated with these things.
Have there been any controlled studies on long-term follow-up of cognitive
ability of women who have received chemotherapy for breast cancer?
Ganz: Some of the studies that we and others have done have been in
long-term breast cancer survivors. As I indicated the changes in cognitive
functioning that we see on tests are very subtle and don’t necessarily
correlate with women’s complaints. Another challenge that we have is that
the women who have been studied are highly selective and we really need to
see a representative sample of women that have been treated for cancer to
determine how frequent this is as a long-term problem.
Weiss: In addition, most studies do not have a pre-treatment baseline on
memory and thinking function that could be compared to those after
exposure to the various treatment agents.
Ganz: The other problem that I think is working here is that many women
with breast cancer are very high-functioning professional women with high
IQs, and even the most subtle changes in their memory or ability to do
multiple tasks is noticeable. As Dr. Weiss mentioned earlier, they are
used to doing multiple tasks, which require high levels of attention and
focus and if this is disrupted in even a small way they may become
distressed by their inability to function at the same level. So it may not
necessarily mean they have a tremendous change in their performance, but
it may be that it is in the presence of such a high level of function that
a minor change is noticeable. I’ll give an example from my practice. I
routinely ask everyone I have given chemotherapy to whether they have
noticed any change in their memory or their ability to concentrate. I find
that older women or women who are retired will rarely voice concerns about
this. These are generally women who can set the pace of the day, do not
have work obligations, are not taking care of children and are able to
adjust disruption that this may have caused in terms of receiving cancer
treatment. In contrast, younger women may be trying to work, take care of
their children and house, and deal with the emotional distress of cancer
coming at a time of their life when it is not expected. These women would
more often complain about difficulties with concentrating, memory, and
doing the multiple tasks that they were used to doing.
Since having chemo I developed neurological problems including restless
legs, nerve pain and numbness in the hands, plus cognitive problems. I am
taking Requip (chemical name: ropinirole Hcl) and Neurontin (chemical
name: gabapentin), and I am tired all the time. Any suggestions?
Weiss: Keep in mind that you live with yourself 24 hours a day and the
expectations that you place on yourself are usually greater than what
others place on you. Therefore, these changes tend to be more noticeable
to you than they are to other people. If you are wondering if other people
are noticing that you may be slipping here or there, ask a close friend or
relative for their honest feedback.
Ganz: Your question really reflects a series of common complaints and
problems women may have after chemotherapy. You may have had a taxane
drug as part of your chemotherapy treatment and this could certainly be
the cause of the pain in your hands and feet. It may certainly be helped
by the Neurontin. The other issue of fatigue again is that a third of
women will report post-treatment fatigue. This may get better over time,
although for some women this may persist. But as we have discussed
earlier, women who are fatigued may also have complaints of difficulty
concentrating, so it is important to try and address your fatigue by
pacing yourself, taking good care of yourself physically, and addressing
any pain or anxiety or depression that you may be having. Some of our
research has actually found immune changes in women who have persistent
fatigue which may possibly explain their difficulty responding to physical
and mental challenges and it is an active area in laboratories. I can’t
say that this is what you have, but it is a definite syndrome that we and
others have found in about a third of women after breast cancer treatment.
Weiss: When Dr. Ganz says take care of yourself, she is very serious about
this. We’re not just talking about handling a crisis in your life and
treating yourself here and there. We’re talking about taking good care of
yourself on an everyday basis, like you would a baby who needs nurturing:
plenty of sleep, lots of liquids, good food, and comfort. You may be doing
too much. You may have to cut back some of the responsibilities and
demands you have in your life. In my practice, I have seen a number of
high-powered women, trying to do it all and do it all well, reach their
breaking point. Under these circumstances I’ve had to step in and insist
that they cut back immediately. This might mean cutting back from
full-time to part-time work, or it might mean taking short-term
disability. There is a reason why those benefits exist. The breast cancer
experience can create crisis for many people, and time off from work can
be very therapeutic. Many patients have also gotten benefit from learning
meditation techniques, doing visualization, regular prayer, quilting,
knitting. Any kind of regular, relaxing, peaceful activity that gets your
mind off of what is stressful onto something that is relaxing, comforting,
and fun are good things. Support groups are another way to learn helpful
tips from other people as well as to get encouragement and support.
Ganz: When you are not feeling your best, you must be careful about your
safety. Do not start cooking and leave the kitchen. Make sure you remember
to put your safety belt on. Schedule various tasks and things that you
have to do or remember and write them down. Rather than depend on your
memory for a lot of mundane, everyday tasks, use list-making and other
prompts to help you remember.
I am taking Herceptin and radiation. Could that interfere with sound
Weiss: The demands of daily radiation (delivered five days a week over
about five to seven weeks) can disrupt your regular routine. It adds one
more big task onto each day. If your radiation follows chemotherapy, then
radiation can add to fatigue that you still have left over from your
chemo. Most people who use Herceptin
(chemical name: trastuzumab) are taking it with or beyond their
chemotherapy, so the fatigue they may experience while on Herceptin and
radiation may in part be left over from all prior forms of treatment.
Radiation to a large area can lead to a drop in blood count, but this is
usually a relatively small drop and unlikely to cause significant fatigue.
Radiation can be associated with various types of discomfort including
shooting pain, soreness, and skin irritation. Towards the end of radiation
and for the first few weeks afterward, these symptoms might wake you up at
night. The good news is that the discomfort can usually be treated with
over-the-counter medication and with a good skin care protocol.
Are younger women experiencing this cognitive difficulty at the same rate
as older women?
Ganz: That’s an excellent question. We really haven’t had large enough
studies of women of all ages to answer this question. My clinical
impression is, though, that this is more common in women less than 55
years of age.
In the 2002 conference, it was mentioned that there was a study that was
going to look at stimulant-type drugs in helping with attention and
fatigue. What were the results of this study?
Ganz: There has been a study underway being conducted by investigators in
Toronto. As far as I’m aware, it has not become available either in a
scientific presentation or published paper.
Weiss: Until we know more about the role of stimulants, be careful with
their use. Stimulants, which include coffee and other medications, affect
people in very different ways. I would only consider their use with
careful medical management.
I couldn’t get here in time for the conference (I didn’t forget it
though!). Will there be a way to read it later?
Weiss: Yes. We will post it approximately one week after the conference.
It will be available through breastcancer.org in the Support &
Community area. Click on Ask-The-Expert Online Conferences. Please sign up
for our free email updates, which will include a link to the transcript.
There are a lot of holidays coming up this fall. As you receive
invitations to join family and friends make sure you write down the names
of people from whom you’ve accepted invitations. Many patients who are in
the midst of treatment may accept more than one of these invitations, not
remembering that they had made a previous commitment. This is just one
example of using a simple system, a calendar, to organize some of the
important events in your life.
I had invasive ductal carcinoma and ovarian cancer, with six treatments of
Cytoxan/Adriamycin/5FU for the breast cancer, and four treatments of
Taxotere [chemical name: docetaxel] and carboplatin [brand name:
Paraplatin] for the ovarian cancer. How long will chemo brain affect me? I
am 42 and it aggravates me when I know what I want to say but can’t get
the words to come out right. Is this a forever thing?
Ganz: It sounds like you have had a lot of treatment for two cancers and
that’s a lot to go through. I also assume because of your ovarian cancer
that you are post-menopausal surgically for treatment of this cancer.
Surgical menopause (removal of the ovaries) leads to very extreme symptoms
that are more severe than the normal onset of menopause or even the
chemotherapy-induced menopause that I described earlier. Some of the
problems you are having in finding words may be related to estrogen loss.
Like I said earlier, difficulty in finding words is commonly experienced
as a result of menopause and hopefully your brain will adjust to the new
hormone environment your brain is functioning in.
I was told that my cognitive problems with Arimidex are side effects of
loss of estrogen. My symptoms are verbal function, flow of thinking, and
memory loss. I was also told by my psychiatrist that if I take Wellbutrin
(chemical name: bupropion HCI), it will help my serotonin levels and help
with this problem. I would like you to address taking anti-depressants to
alleviate the cognitive issue.
Ganz: Thank you for your interesting question. At this point in time we
don’t have enough studies to address your concern about cognitive problems
and their association with Arimidex. I think this is a real possibility;
that is, when women take a drug like Arimidex their estrogen levels fall
to extremely low levels, almost zero. And for some women this may possibly
affect how they’re able to do verbally and recall words due to the low
estrogen state. However, this is not universally true. Most women on
Arimidex do not complain about these problems and we need to do more
research to know who’s at risk. I’m not personally aware of any studies
that have shown Wellbutrin to help in these situations, but perhaps your
doctor has had some clinical experience with this treatment strategy.
Dr. Weiss: Over time, women tend to be very adaptive and learn how to compensate for changes in their lives, including changes in their ability to function relative to memory and thinking. It is a good time to be resourceful and creative about various ways that you can compensate for these changes in your life. Also keep in mind that each one of you is unique and different. You may have had preexisting challenges with thinking, attention, memory, learning, concentration, etc. It’s unlikely that those problems will go away with treatment. More likely they can become more pronounced through treatment and beyond. It’s true that a breast cancer diagnosis may make you confront some of the issues that may have been present in your life prior to your diagnosis. Some of these issues can include problems with depression and anxiety, which should be addressed at this time. There are a lot of very capable health professionals who can make a big difference in your life by listening to your concerns, figuring out what’s happening in your life overall, and helping you manage the situation. It will require a lot of introspection as well as patience and persistence.
Ganz: Also to complement what Dr. Weiss has said, women who have experienced
many women—not all, but many—find the strength and resilience to move
forward in their lives and see the positive aspects of this experience.
You are all very courageous and we hope to find better ways to support you
through the difficulties such as the things we’ve talked about tonight.
Thanks for being with us this evening. We hope the support and information
you’ve gotten here tonight will help you discuss some of these issues with
your doctor and make the best choices for YOU. We also look forward to
hearing from you at future Ask-the-Expert Online Conferences right here at
materials presented in these conferences do not necessarily reflect the
views of breastcancer.org. A qualified healthcare professional should be
consulted before using any therapeutic product or regimen discussed. All
readers should verify all information and data before employing any
therapies described here.