- Question from Carson: Why do doctors not address this with patients when they ask questions? I was treated like the village idiot by my oncologist and am changing doctors now because of it.
- Answers - George Sledge, M.D. This is an area where medical oncologists have difficulty, partly because the sophisticated neuropsychology testing is not available to the medical oncologist in the clinic. Partly it's because this is an area where physicians are good at taking care of acute toxicities of therapy but not nearly as good at taking care of chronic toxicity. And finally, unfortunately but realistically, having these discussions actually takes a fair amount of time in the clinic, and medical oncologists are frequently running in and out of rooms quickly to get through the day. That's not an excuse, but it's a reality.
- Christina Meyers I agree. Unfortunately, it means that patients need to be their own advocates. Patients need to be informed and they need to ask what they need — a sleep study or a physical therapist or a neuropsychologist. They need to promote it as patient advocacy. Dr. Sledge is right — physicians have limited time. They just do. And you need to know what kind of treatment you need and ask for a referral.
- George Sledge, M.D. Like many things in medicine, this is a rapidly evolving field, and how we addressed it 10 years ago is different from how we address it now. The reality is that for many medical oncologists, because their training is in cancer treatment instead of the brain, they have trouble dealing with this. The informed consent forms even today have minor mention of potential cognitive problems, partially because we don't have enough data to give patients enough information.
- Christina Meyers And a lot of the things in informed consent are about what can kill you, and chemo brain is not fatal. We're not talking for most people about a horrible thing; we're talking about an aggravating problem that keeps them from doing their normal activities in their normal fashion. It has to be in perspective.
- George Sledge, M.D. I think this is part of a larger trend we're seeing in oncology. In the recent past, oncologists considered themselves heroic if their patients survived 5 years out. Now that patients survive 5, 10, 15 years out, we are seeing more long-term effects.
- Christina Meyers In fact, it is a chronic problem now instead of an acute problem. It's a chronic disease you keep treating as it flares up.
The Ask-the-Expert Online Conference called Managing Chemo Brain featured Christina Meyers, Ph.D., A.B.P.P. and George Sledge, M.D. answering your questions about how long chemo brain can last, what treatments can be helpful, and current research on cognitive effects of breast cancer treatment.
Editor's Note: This conference took place in October 2008.
The 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.
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