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Managing Stress and Memory Lapses After Breast Cancer Diagnosis

Stress Management, Breast Cancer, Chemo Brain

After a diagnosis of breast cancer, it is certainly understandable that women are stressed about their treatment plan and the ultimate outcome. A new study finds that women who were unable to cope with stress were more likely to experience cognitive declines – “chemo brain” even before chemotherapy started.

The term “chemo brain” refers to a mental fog that many cancer patients experience before, during and after chemotherapy. Patients describe memory lapses (forgetting things they would normally have no trouble recalling), difficulty concentrating and taking longer to finish a task, and are less likely to be able to do more than one thing at a time. Patients who undergo radiation often experience similar types of problems, but doctors are recognizing that patients experience these symptoms even before their treatments start.

Stephanie Reid-Arndt, an associate professor and chair of the Health Psychology Department in the University of Missouri School of Health Professions, examined 36 women with breast cancer who had undergone surgery but had not yet received chemotherapy or hormone-replacement therapy. The women completed neuropsychological testing and psychological questionnaires.

Patients who were stressed and had passive coping strategies to deal with their stress (ie: denial, disengagement, helplessness) were more likely to experience cognitive declines and performed lower on memory and attention tests. For example, twenty-seven percent of the women displayed deficits on at least one measure of verbal fluency.

The body responds to stress by releasing hormones such as epinephrine (also called adrenaline) and cortisol. These hormones increase blood pressure, heart rate and blood sugar levels. Chronic stress is also thought to weaken the immune system.
In the brain, cortisol interferes with the function of neurotransmitters, the chemicals that brain cells use to communicate with each other. Excessive stress hormone levels can make it difficult to think or retrieve long-term memories.

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"Teaching patients proactive ways to deal with stress can help them improve their quality of life as well as maintain their cognitive function," Reid-Arndt said. She notes that too often, women receive a breast cancer diagnosis and immediately begin treatment without having much time to emotionally prepare. Health care providers should identify patients who are experiencing psychological stress and offer effective ways to manage it. Women, too, should be encouraged to acknowledge that they are overwhelmed and need help from family, friends, and other support systems.

In addition to opening up to a trusted friend, yoga and meditation techniques have been shown to be powerful stress reducers. One such type of training studied in breast cancer patients is called the “Mindfulness-Based Stress Reduction” program that blends meditation, yoga, and physical awareness. Jane Armer, one of the founders of MBSR, says that the practice gives breast cancer survivors a “new way of thinking” that improves long-term health outcomes from helping women gain more control over their lives.

In addition to managing stress, yoga has been shown to improve feelings of persistent fatigue, which occurs in at least one-third of breast cancer patients, improve physical mobility and relieve pain.

Also be sure to take care of your physical health by eating a healthy balanced diet with regular meals, drink plenty of water, get adequate rest, and schedule time for yourself each day. Even ten minutes a day of “personal time” can help refresh your mental outlook.

For those experiencing memory loss, the American Cancer Society offers these tips:

• Use a detailed daily planner. Keeping everything in one place makes it easier to find the reminders you may need. Serious planner users keep track of their appointments and schedules, “to do” lists, important dates, websites, phone numbers and addresses, meeting notes, and even movies they’d like to see or books they’d like to read.
• Exercise your brain. Take a class, do word puzzles, or learn a new language.
• Get enough rest and sleep.
• Exercise your body. Regular physical activity is not only good for your body, but also improves your mood, makes you feel more alert, and decreases tiredness (fatigue).
• Eat your veggies. Studies have shown that eating more vegetables is linked to keeping brain power as people age.
• Set up and follow routines. Pick a certain place for commonly lost objects and put them there each time. Try to keep the same daily schedule.
• Don’t try to multi-task. Focus on one thing at a time.
• Ask for help when you need it. Friends and loved ones can help with daily tasks to cut down on distractions and help you save mental energy.
• Track your memory problems. Keep a diary of when you notice problems and the events that are going on at the time. Medicines taken, time of day, and the situation you are in might help you figure out what affects your memory. Keeping track of when the problems are most noticeable can also help you prepare. You’ll know to avoid planning important conversations or appointments during those times. This will also be useful when you talk with your doctor about these problems.
• Try not to focus so much on how much these symptoms bother you. Accepting the problem will help you deal with it. As many patients have noted, being able to laugh about things you can’t control can help you cope. And remember, you probably notice your problems much more than others do. Sometimes we all have to laugh about forgetting to take the grocery list with us to the store.

Source References:
Stephanie A. Reid-Arndt and Cathy R. Cox; Stress, Coping and Cognitive Deficits in Women After Surgery for Breast Cancer; JOURNAL OF CLINICAL PSYCHOLOGY IN MEDICAL SETTINGS. DOI: 10.1007/s10880-011-9274-z
American Cancer Society – Chemo Brain
National Cancer Institute – Psychological Stress and Cancer