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Cognitive Problems Common for Young Women After Treatment

March 22, 2013

Written By Robin Warshaw
Reviewed By Carolyn Weaver RN, MSN, AOCN, AHN-BC

A study looking at long-term memory loss and other cognitive impairment in young women treated for breast cancer found almost 60 percent reported problems during the 28 months following diagnosis. 

Published online in The Breast Journal, the study was conducted in southeastern France.

Background and Reason for the Study

After treatment for breast cancer, many women report trouble concentrating, thinking and remembering.

Cognitive troubles after treatment are often referred to as chemobrain. But some research has shown chemotherapy to be related to memory and thinking problems, while other research has not. Other factors that could contribute to chemobrain include stress, fatigue, depression, anemia, aging, other medicines and even the cancer itself.

While cognitive changes are often minor and do not last permanently, they can be bothersome and may last awhile.

Young women diagnosed with breast cancer may be more likely to feel these side effects than older women because they have not had age-related changes in thinking or memory before. Previous research suggests depression and fatigue are common in young women after diagnosis, which can cause cognitive problems. 

The researchers wanted to assess the frequency of long-term cognitive changes over time after diagnosis among young, premenopausal women. They also hoped to identify any contributing factors. 

Study Structure

Using information from a national French health registry, the researchers invited women aged 18 to 40 to participate in the study. The women were premenopausal at diagnosis (stage 0 to III) and all lived in southeastern France. After screening for eligibility, 222 women were included.

Researchers gathered information in telephone interviews with the women and from medical and prescription records. Data was collected 10, 16 and 28 months after diagnosis. 

At each interview, the women reported how often they had memory loss, attention deficits and related difficulties. Researchers also asked the women about cognitive problems they experienced in the six months before diagnosis.

Findings

The study shows that, for many young women, cognitive problems develop or continue after breast cancer treatment.

Study participants were:

  • Average age 37
  • 5.4 percent were not native French speakers
  • 45.5 percent had education beyond secondary school
  • 79.3 percent had chemotherapy; 50.5 percent had hormonal therapy
  • Before diagnosis, 12.2 percent had prescriptions for sedatives or tranquilizers and 6.8 percent for antidepressants
    • From diagnosis to 10 months later, 59 percent were given sedatives or tranquilizers and 18.5 percent received antidepressants

Women reporting cognitive problems:

  • 6 months before diagnosis – 21.2 percent
  • 10 months after diagnosis – 37.4 percent
  • 16 months after diagnosis – 36.5 percent
  • 28 months after diagnosis – 42.3 percent

Over the entire study, 58.1 percent of women reported cognitive difficulty during at least one interview (20.7 percent reported problems at all interviews). 

The researchers found impairment was primarily due to “psychosocial vulnerabilities” and breast cancer treatment. At 28 months after diagnosis, women who reported trouble with memory, attention and related conditions were more likely to:

  • Have a chemotherapy history
  • Use sedatives or tranquilizers (but not antidepressants)
  • Not have completed secondary school
  • Not be native French speakers

Sedatives and tranquilizers have known side effects on cognitive function, the researchers said. They also noted that continuing cognitive difficulty may increase the “social frailty” of women with lower education levels or who are non-native language speakers.

After adjusting for other factors, cognitive impairment caused by chemotherapy was shown to be temporary and appear late, two years after diagnosis. Difficulties that develop earlier, the researchers believe, may arise from the impact of receiving a breast cancer diagnosis, effects from surgical anesthesia, emotional distress or fatigue.

Hormonal therapy did not have an effect on cognitive impairment.

What This Means for You

You may have experienced cognitive changes since being diagnosed or treated for breast cancer. Many young women have had similar problems. This study shows that difficulties with memory or thinking are real and may be due to chemotherapy or other causes.

Keep track of when your symptoms occur and talk with your doctor about them. Use a detailed daily planner, lists or reminder messages to organize and recall information. 

If stress, fatigue or depression concern you, try adding some physical activity into your day. Take a walk, ride an exercise bike or join a yoga class to help build energy and lift your spirits.

Other ways to keep your brain healthy are to eat several servings of vegetables daily, get enough sleep and exercise your brain (do puzzles, take a class).

Calming activities such as deep breathing, meditation, guided imagery and Reiki may also be helpful.

D Rey, AD Bouhnik, J Mancini et al. Self-Reported Cognitive Impairment After Breast Cancer Treatment in Young Women from the ELIPPSE40 Cohort: The Long-Term Impact of Chemotherapy. The Breast Journal, July 25, 2012 [epub ahead of print].

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

 

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