Educational Information: Issues for Survivors

Rehabilitation after cancer presents challenges for patients, physicians.

On the front of its Personal Journal section, the Wall Street Journal (10/11, D1, Beck, Subscription Publication) reports on the issues facing survivors of breast cancer. Side effects of treatment include heart damage, nerve damage, fatigue, secondary cancers due to treatment, sleep problems, sexual problems, or osteoporosis. One highlighted issue is various estrogen-blocking drugs, which can keep certain breast cancers at bay but bring side effects of menopause, blood clots, uterine cancer, or osteoporosis. Notably, a study in the Journal of Clinical Oncology found that only about 50% of patients keep taking such drugs for five years, even though the drugs can increase survival.

The Washington Post /Kaiser Health News (10/11, Graham) reports on the "'prospective surveillance model' of cancer rehabilitation," which "involves evaluating patients soon after diagnosis and then at regular intervals -- typically every three months, for up to a year -- once treatment is complete. If emerging problems are identified, they can be addressed promptly." Notably, "researchers estimated that treatment for breast-cancer-related lymphedema cost $636.19 a year when the prospective surveillance model was used vs. $3,125 for traditional treatment. ... In February, officials from" groups, including the American Society of Clinical Oncology, "met to review evidence supporting the prospective surveillance model and to consider promoting its widespread adoption. Proceedings from that meeting will be published early next year."

Women diagnosed with breast cancer during pregnancy may have high survival rates.

The Los Angeles Times (9/30, Healy) "Booster Shots" blog reported that "pregnant women treated for breast cancer are more likely to survive their ordeal than breast cancer patients of the same age who were not pregnant when their cancer was diagnosed," researchers at the MD Anderson Cancer Center found after following 225 patients. "Five years after their diagnosis, almost 74% of the women diagnosed with breast cancer during pregnancy were still alive," while 55.75% of their "sisters who were not pregnant when they got treatment" survived "to the five-year mark." The "study's findings, to be presented Friday at the American Society of Clinical Oncology's Washington, DC, meeting, are likely to help lay to rest the lingering belief that pregnancy is a uniquely dangerous time for a woman to discover breast cancer."

Chemotherapy may be associated with reduced brain gray matter density in breast cancer patients.

MedWire (10/6, Dean) reported that Indiana University "researchers have used magnetic resonance imaging (MRI) to show that chemotherapy is associated with reduced brain gray matter density in breast cancer patients, which partially recovers over time." According to the paper in Breast Cancer Research and Treatment, "gray matter changes were most prominent in frontal, temporal, and cerebellar regions, consistent with the profile of cognitive dysfunction observed in breast cancer patients after chemotherapy."

Chemotherapy Affects Brain Structure of Breast Cancer Patients

A new study has provided some of the strongest direct evidence to date that chemotherapy has physical effects on areas of the brain that, when altered, could result in the array of cognitive symptoms that is often called “chemobrain.” The study was published online August 6 in Breast Cancer Research and Treatment.

In a small study of women with breast cancer, researchers from the Indiana University School of Medicine used MRI scans to show that chemotherapy was associated with a decrease in the density of brain gray matter. The affected areas include those involved in memory and in the ability to process information. Although several other studies have shown similar changes in these areas of the brain, this was the first study to follow women prospectively and to compare scans before and after chemotherapy.

“The alterations in gray matter density observed in the [chemotherapy] group areā€¦ consistent with the pattern of cognitive complaints and impairment found in neurocognitive studies,” wrote Dr. Andrew J. Saykin and colleagues.

The study included 17 women with breast cancer who underwent chemotherapy after surgery, 12 women with breast cancer who did not receive chemotherapy after surgery, and a control group of 18 healthy women. The initial MRI scans, performed shortly after surgery in the participants with cancer, showed no notable differences in gray matter density among the three groups. One month after completion of chemotherapy, however, MRI scans revealed notable decreases in gray matter density in women with breast cancer, as well as changes in gray matter density in women who received surgery only, although the changes for these women were not as great. No changes were seen in women in the control group. After 1 year, women treated with chemotherapy had recovered gray matter losses in some regions, but other deficits persisted.

Exactly how chemotherapy may be causing these changes is unclear, said study co-author Dr. Brenna McDonald. “However, the finding that the changes appear to resolve naturally to some degree in the first year after chemotherapy is completed is a very positive one,” she wrote in an e-mail message. Because of the limited follow-up in the study, she continued, it’s unclear how much further recovery may occur naturally. A number of studies have shown that such cognitive effects can persist for many years, she added. Additional studies are investigating whether other therapies, such as tamoxifen, may have similar effects on brain structure.

For more information on this topic, see: “Delving Into Possible Mechanisms for Chemobrain.”

Sexual problems may be more common among breast cancer survivors.

CNN (9/24, Peeples) reports, "Many middle-aged women report sexual problems, including a loss of libido and a less-than-satisfying sex life." Now, research from Australia "suggests these problems are even more common among women who have had breast cancer. In fact, seven in 10 breast cancer survivors experience sexual problems in the two years after their diagnosis."

That figure is based on information stored in the "database of the BUPA Foundation Health and Wellbeing after Breast Cancer Study, an ongoing investigation of physical, psychological, and socioeconomic consequences of the disease," MedPage Today (9/23, Bankhead) reported. Monash University Researchers zeroed in on "1,588 BUPA participants who completed the initial follow-up questionnaire," according to the paper in the Journal of Sexual Medicine. "Overall, 58.5% of the participants reported one or more issues related to sexual function, including 70% of 1,011 women younger than 70 and with regular partners."

The team also found that "women taking aromatase inhibitors as treatment for their breast cancer reported more sexual problems than women taking tamoxifen," WebMD (9/23, Boyles) reported. "Body image issues and vaginal dryness related to aromatase inhibitor use were among the most frequently mentioned complaints. Even women who have breast-sparing surgery may no longer enjoy having their breasts touched during sex because it reminds them of their cancer and treatment." However, the majority of the participants "described their sex lives as satisfying before breast cancer."

These issues can be addressed, however, by, among other things, "bringing the partner in on the discussion," HealthDay (9/23, Doheny) reported. "For libido and body image issues," one expert "said a woman might consider psychological therapy." And, "women who want a satisfying sex life shouldn't think of themselves as frivolous," as "sexual functioning" is considered "a part of wellness."

Newly released guidelines aim to help patients deal with breast, lung cancer.

The Los Angeles Times (9/23, Khan) "Booster Shots" blog reported that, after a cancer diagnoses, in addition to the sheer anguish, patients have to "sort through information about the disease, possible treatments and the repercussions of each," necessities that "can seriously compound the nightmare." Aiming "to ease that process," the "National Comprehensive Cancer Network on Thursday released the first two of a series of guides for patients dealing" specifically with breast or lung cancer. Although they "are meant to be user-friendly versions of the network's cancer guidelines for clinicians," one physician maintained the "patient guidelines overlook some basic patient concerns," adding, "I can't recall a single patient who asked me about the molecular studies of her tumor."

Weightlifting program does not raise risk of lymphedema in breast cancer survivors.

The Los Angeles Times (12/8, Stein) "Booster Shots" blog reported, "Breast cancer survivors sometimes avoid strength training for fear it could increase their chances of lymphedema, blockage of the lymphatic system." Now, a new "study finds that a yearlong weightlifting program did not raise the risk of lymphedema among women who had had breast cancer." The study published in the Journal of the American Medical Association found "those in the weightlifting group got stronger (no surprise there) and had a lower percentage of body fat that those in the control group."

The Chicago Tribune (12/8, Deardorff) "Julie's Health Club" blog reported, "A gradual weight training program may slash lymphedema risk by as much as 70 percent, according to the research from the University of Pennsylvania School of Medicine." The new data, "combined with the team's previously published research showing that the weight training exercises prevented lymphedema from getting worse in women who already have it, should inspire women to push for a referral to a physical therapist, said Kathryn Schmitz, an associate professor of epidemiology and biostatistics at Penn and the study's lead author."

MedPage Today (12/8, Phend) reported, "The findings should eliminate the concerns traditionally conveyed to breast cancer survivors in instructions to avoid lifting heavy items with their at-risk arm, the researchers noted." Many women "limit their use of the at-risk arm out of fear and uncertainty, which deconditions the arm and thus actually boosts potential for injury, overuse, and, ironically, lymphedema, Schmitz's group noted." HealthDay (12/8, Gardner) also covered the story.

More Articles