Cognitive changes and their impact on functioning at work: A qualitative study on women with breast cancer / Maryam Hafsah Mohammed Selamat

Cancer-related cognitive impairment or chemobrain is an increasingly acknowledged after-effect of cancer treatment. It has occurred in 15 to 70 percent of patients. However, evidence of its presence is limited along with limited published articles on it. The aim of this study is to understand the phenomenon of chemobrain from qualitative perspectives. The objectives therefore are: i) to review qualitative studies that explored the lived experience of chemobrain among breast cancer survivors, with particular attention to its impact on daily living and quality of life; ii) to explore the perspectives from a) post-chemotherapy working women on the level of awareness and perceived impact of cognitive changes, and suggestions for suitable management b) health care providers (oncologists) on chemobrain issues. METHODS: This is a two-stage study to explore and to understand the phenomenon of chemobrain in cancer survivors. In stage one, a qualitative systematic review using meta-ethnography approach and conducted with selected keywords. 10 electronic databases were searched. Stage two involves a) four focus groups interview with breast cancer survivors (n= 17) and b) an in-depth interview with oncologists (n = 12). Thematic analysis and constant comparative method were used to explore the common and unique themes across participants. RESULTS: In stage one study: data was extracted from seven selected papers and concepts were analysed using a meta-ethnography approach. Final synthesis resulted in four new order interpretations: i) the chemobrain struggle, ii) the substantial impact of chemobrain on life domains, iii) struggling to self-manage, and iv) ‘thankful yet fearful’ representation. In stage two study: the focus group discussion with the survivor revealed five themes. These were: i) varying level of awareness, ii) debilitating impact on work iii) social climate at the workplace and iv) trying to self-manage. Meanwhile, the thematic analysis of in-depth iv interviews with the oncologists revealed three main emerging themes: i) lack of awareness ii) beliefs and attitudes on chemobrain and iii) future direction on chemobrain. DISCUSSION: Awareness of cognitive changes was context-dependent in healthcare settings and cultural contexts which appeared as strong determinants. Subjects verified the existence of chemobrain, but healthcare providers mis-recognised, under-recognised, and even negated it, perhaps due to its uncertain aetiology. Qualitative findings from the review as well as from focus groups with survivor confirmed that chemobrain brain impacted the work functioning of survivors. The lack of awareness, beliefs on the conception of the chemobrain between both patients and healthcare providers contributed to the poor acknowledgement and a lack of striving to address chemobrain in cancer survivors. CONCLUSION: The current literature on findings from the lived experiences of women’s experiences of chemobrain and the in-depth qualitative findings provided a consistent report that chemobrain is real and persistent with detrimental impacts on work functioning (manifested as constant struggles) and on the quality of life of breast cancer survivors

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

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

Critical Appraisal Skill Program (CASP Quality appraisal criteria).

<p>The first two questions are screening questions. If the answer to both is “yes”, it is worth proceeding with the remaining questions. Record a “yes”, “no” or “cannot tell” to most of the questions.</p><p>Critical Appraisal Skill Program (CASP Quality appraisal criteria).</p

Critical Appraisal Skill Program (CASP)’s Quality appraisal for selected papers.

<p>Index N = No, Y = Yes, C = Cannot tell.</p><p>Critical Appraisal Skill Program (CASP)’s Quality appraisal for selected papers.</p

Coping strategies adopted by survivors.

<p>Coping strategies adopted by survivors.</p

This is the <b>Figure 1</b> Search strategy.

<p>This is the <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108002#pone-0108002-g001" target="_blank"><b>Figure 1</b></a> Search strategy.</p

Synthesis of concepts, with second and third order interpretations.

<p>2nd order construct interpretations of participants' understandings made by authors of these studies (and usually found in the discussion and conclusion section of an article). 3rd order construct the synthesis of both first and second order constructs into a new model or theory about a phenomenon.</p><p>Synthesis of concepts, with second and third order interpretations.</p

Interpretation based on Illness Representation Theory – the struggle of Chemobrain.

<p>Based on the Leventhal’s Common Sense Model of Illness Representation <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108002#pone.0108002-Leventhal1" target="_blank">[31]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0108002#pone.0108002-Leventhal2" target="_blank">[40]</a>.</p><p>Interpretation based on Illness Representation Theory – the struggle of Chemobrain.</p

Characteristics of the selected studies.

<p>1st order construct - Constructs that reflect participants’ understandings, as reported in the included studies and usually found in the results section of an article.</p><p>Characteristics of the selected studies.</p