Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications

Maryam Hafsah Selamat; Siew Yim Loh; Lynette Mackenzie; Janette Vardy

doi:10.1371/journal.pone.0108002

Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications

PLoS One. 2014 Sep 26;9(9):e108002. doi: 10.1371/journal.pone.0108002. eCollection 2014.

Authors

Maryam Hafsah Selamat¹, Siew Yim Loh², Lynette Mackenzie³, Janette Vardy⁴

Affiliations

¹ Department of Postgraduate Studies, University of Malaya, Kuala Lumpur, Malaysia.
² Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
³ Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
⁴ Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.

Abstract

Background: Cognitive impairment, colloquially termed "chemobrain", occurs in 10-40% of all cancer patients, and is an emerging target of cancer survivorship research.

Aim: This study reviews published qualitative studies to explore cognitive impairments or chemobrain among breast cancer survivors, with particular attention given to the impact on quality of life.

Method: Using keywords, we searched ten electronic databases (CINAHL, EMBASE, Proquest, OVID SP, MEDLINE, Oxford Journal, Science Direct, PubMED).

Findings: Of 457 papers, seven relevant papers were included. Data was extracted and concepts were analysed using a meta ethnography approach. Four second order intepretations were identified, on the basis of which, four third order intrepretations were constructed. Linked together in a line of argument, was a consistent account on their struggles to self-manage the chemobrain impairments that impact their daily lives. Five concepts emerged from the analysis of the primary findings: i) real experiences of cognitive changes, ii) calls for help, iii) impact of cognitive impairments, iv) coping and v) survivorship and meaning. Further synthesis resulted in four new order intepretations: i) The chemobrain struggle, ii) The substantial impact of chemobrain on life domains, iii) The struggle to readjust and to self manage, and iv) 'thankful yet fearful' representation.

Discussion: Awareness of cognitive changes were context-dependent on healthcare settings and cultural contexts as strong determinants. Subjects verified the existence of chemobrain but healthcare providers mis-recognised, under-recognised, and sometimes negated it perhaps due to its unknown aetiology. Asian breast cancer survivors appear less vocal than their western counterparts.

Conclusion: The current literature on the lived experiences of how women experienced chemobrain provides a consistent report that chemobrain is real, persistent and with detrimental impacts on quality of life - manifested as a constant struggles. A greater awareness of the effects of chemobrain with improved functional assessment and interventions is warranted.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological
Breast Neoplasms / complications*
Breast Neoplasms / psychology*
Cognition Disorders / etiology*
Delivery of Health Care
Female
Humans
Qualitative Research
Survivors / psychology*

Grants and funding

This study is funded by the University Malaya Research Grant (UMRG 477/12htm). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.