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Abigail KamenOssining High SchoolOssining, New York

www.meraki.com blog.consumerbell.com

Determining Cancer Patient Awareness of Cognitive Impairment Secondary to Chemotherapy

Introduction

Image Source: www.radionowindy.com

• Approximately one in every eight women will develop breast cancer over the course of her lifetime (American Cancer Society, 2012)

5 years

10 years

20 years

0 10 20 30 40 50 60 70 80 90 100

Pancreas LungLeukemiaColonBreast

• Survival rates in breast patients are higher than in other cancer sites (Brenner, 2002)

Introduction

Left

Right

Healthy Control (1 month after baseline)

No chemotherapy (baseline)

Chemotherapy(1 month after baseline)

Image Source: McDonald et al., 2010

Introduction • “Chemobrain” - The mild deterioration of cognitive

function secondary to chemotherapy (Jansen et al., 2005)

“it seems like most of [the doctors] are very

insensitive…”

Introduction

“Frustrated” “Scared” “Unsure”

“…I wish that whether it’s a doctor or a patient care coordinator or somebody, would sit down with a patient and

talk to them [and say] ‘You know, you may not get it, but these are some of

the things that happen…just be aware, so that you don’t get frightened that you are losing it or aren’t meeting everybody’s expectations.’” (Boykoff et al.,

2009)

“it seems like most of [the doctors] are very

insensitive…”

Introduction

“Frustrated” “Scared” “Unsure”

“…I wish that whether it’s a doctor or a patient care coordinator or somebody, would sit down with a patient and talk to them [and say] ‘You know, you may not get it, but these are some of the

things that happen …just be aware, so that you don’t get frightened that you

are losing it or aren’t meeting everybody’s expectations.’” (Boykoff et al.,

2009)

Introduction

White Black Hispanic0%

10%20%30%40%50%60%70%80%

Awareness of CVD by Race

Awareness

• African American and Hispanic women had lower levels awareness of heart disease as their leading cause of death than did white (Christian et. al., 2007)

Negative impact on patient Quality of Life (QOL) (Wefel et al., 2004)

ChemobrainIntroduction


Chemobrain

How well are patients informed about the

possibility of chemobrain

Introduction


Chemobrain

How well patients are informed about the


Is chemobrain awareness related to QOL or depression

Introduction


Chemobrain

How well patients are informed about the


Is chemobrain awareness related to QOL or depression

Are there differences in awareness of

chemobrain between ethnic groups

Introduction

Purpose/Hypotheses

Investigate levels of chemobrain awareness and attitudes toward the patient education process

Determine if there are differences in awareness of chemobrain between ethnic groups

Patients will have some awareness of the risk of chemobrain from outside sources, rendering the patient education process

as unsatisfactory

To study levels of breast cancer patient awareness of chemobrain in relation to patient QOL and levels of depression

A lack of chemobrain awareness will be associated with lower QOL and a higher level of depression in breast cancer patients

Patients who identify as being Hispanic or African American will be less aware of chemotherapy related cognitive decline than non-Hispanic whites

Methods- SampleParticipants• A cohort of 27 female breast

cancer patients varying in: • Socioeconomic status • Ethnicity

Recruitment• Internet Data Exchange (IDX) system potentially eligible patients• Consultation day or subsequent chemotherapy infusion sessions

• 35.7% Hispanic• 50.0% Black • 7.1% Caucasian• 7.1% Asian

• 60 minute baseline survey • Administered by paraprofessional• Conversational style• QOL, levels of depression, ethnic

background

Intake Assessmen

t

Methods- Measures

• 15-20 minute follow up interview• Three-month intervals• Over the phone or in-person

Chemobrain Questions

Methods- MeasuresIntake Assessment

Quality of Life Appraisal Profile

(Rapkin, 2004)

Patient Health Questionnaire (PHQ-9)

(Kroenke et al., 2001)

Novel Instrument • Multiple choice

• “yes”, “no”, “I don’t know,” and “Didn’t answer”• Skip pattern • Open ended

• Meaning of “chemobrain”• Information provider

Methods- Measures

Methods- Data Analyses• SPSS Version 19.0• P-value

• <0.05 = Significant• Between 0.05 and .1 = Trend

• Scaled Variables• Pearson Correlations

• Categorical Variables• Paired t-tests

Results- Demographics

• A majority of the patients in the study identified as being part of a minority

• Average educational level was 12 years

………………………............ …………………………...……………………...…. …………………………...

……………………………… ………………………..…

Results- Descriptive Stats

2 participants had heard of the term “chemobrain,” or difficulty thinking and concentrating after chemotherapy

Results- Descriptive

10 reported that their doctor or nurse had not spoken to them about the possibility for cognitive decline following chemotherapy treatment

Results- Descriptive Stats “Sometimes [I] forget

certain things, like making important phone calls.

Also, [I] forget what was told to me.”

• 39% reported experiencing chemobrain symptoms

• Only 17% of those patients told their clinician about the symptoms

However…

Results- Correlations/Comparisons

*.05 < p < 1.0 Trend

• Limitations of the study include small sample size*

Table 4: Relationships between key variablesExperienced Chemobrain Symptoms

Aware of Chemobrain

N=13

P = .057

Attribute Chemobrain Symptoms to Chemotherapy Treatment

Aware of Chemobrain

N=5

P = .053

Results- Correlations/Comparisons

• No significant comparisons found between chemobrain awareness and QOL or between chemobrain symptoms and depression

• 0% of the patients who identified as being African American or Hispanic were aware of chemobrain

• 100% of Caucasian participants demonstrated awareness of chemobrain

DiscussionAfrican American and Hispanic populations are at greater risk for advanced disease and poorer medical outcomes than white (Li et al., 2003; Jemal et al., 2004)

Average number of years of education for minority patients was equivalent to that of a high school education or less

100% of those aware of chemobrain were Caucasian

In this study…

This indicates…Minority patients are less aware of the possibility of cognitive decline following chemotherapy

Applications and Future Research

Image Source: Myers et al., 2008

• Previous research has not examined attitudes toward the content of the patient educational process surrounding chemobrain from the perspective of health care providers

Applications and Future ResearchPhase Two

• Educational programs and materials as well as supportive interventions must be developed to allow clinicians to properly observe and address these symptoms in their patients

Conclusion1. A lack of

conversation about chemobrain between minority patients and

their care team

2. Low awareness of chemobrain

3. Patients unwilling to bring it up to their

clinician

Patient interventions and education strategies could help maintain a high QOL

in cancer patients

Acknowledgments I would like to thank:

• My mentors, Dr. David Lounsbury, Rhea Howell and Anton Palma for all of their guidance and direction

• My teachers, Mr. Piccirillo and Ms. Holmes for their dedication and guidance

• My family for their continued insight and support

Abigail KamenOssining High SchoolOssining, New York

www.meraki.com blog.consumerbell.com

Determining Cancer Patient Awareness of Cognitive Impairment Secondary to Chemotherapy

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