Cancer Survivorship: Coping After Chemotherapy
Guest: Dr. Cindy Carter – Hollings Cancer Center
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Cindy Carter who is a licensed clinical psychologist and Assistant Professor at Hollings Cancer Center. Dr. Carter, we have been talking some, in an earlier podcast, about the psychological reactions during the first active phase of treatment, after the initial diagnosis. I have heard a lot of people say that one of the really hard times is, once that first round of chemo and/or radiation therapy is over and the doctor says, gee, it looks good for now, see you back in three months. They are sort of going bare without doing something actively on an everyday basis. That can be a very difficult time. Do you want to comment on that?
Dr. Cindy Carter: Certainly. It is a very difficult time for many cancer survivors. It makes a lot of sense when you really think about what is happening at that time in their treatment experience. Typically when someone is diagnosed with cancer, there is an overwhelming amount of information to take in. There is a great deal of treatment decision making that must go in and it can be a whirlwind of activity followed by the initiation of treatment. I think most people who have gone through chemotherapy and/or radiation therapy will tell you that their daily activity planner is quite full with doctor appointments and checks by their physicians. So, they are quite busy during cancer treatment.
When treatment ends, this flurry of activity frequently can diminish quite rapidly. As you mentioned, a recommendation will commonly be made to return in three months for follow-up. So, for some cancer patients, this can be a real difficult transition. You go from high levels of medical surveillance from your doctor and the entire treatment team to very limited surveillance on a daily basis. You also begin to see a diminishment in support, it may be support from family or friends, the idea being, it is over, congratulations. There is a celebration, treatment is done and it is time to return back to normal family life and daily activities.
But, for the cancer patient, it does not feel very normal. It can be a time of isolation, fear of the unknown. That first fear of recurrence can set in and suddenly you are not as action oriented through the treatment process. You are not actively doing something. We can see increased levels of depression and anxiety during this period.
Dr. Linda Austin: Another thing, of course, that can happen is that there can be lingering side effects of chemotherapy, such as chemo brain, or neuropathies. What impact does that have? What is chemo brain? I guess we could start there.
Dr. Cindy Carter: Sure. It can have a profound impact. Chemo brain is a lay term that many survivors use to describe the cognitive effects of chemotherapy. We have known for some time that chemotherapy can have an impact on a range of cognitive functioning, including attention, concentration, memory. For many years there was a belief that most of these symptoms resolved over time. There has been some research, however, over the last five years, to suggest that that might not be true for everyone. There may be some long term effects of chemotherapy on cognitive functioning.
So, people feel that may not be as sharp as they were previously. Their memory may not be quite as tuned in as it was before their treatment. What we do not really know is who and how much this affects people who have completed treatment. People that were very high functioning in their ability to focus, and their attention and concentration, may not have actually experienced deficits, or what we would call clinical changes, in their memory and concentration. But, even minor changes for this type of person may be especially noticeable and worrisome for them.
Dr. Linda Austin: I have worked with patients, myself, as a psychiatrist, where, even in psychological testing, the psychologist could not pick up objective signs that there was anything wrong with their brain. Nor could I really tell, in talking with a person, that there was anything wrong. But, nonetheless, they had a pervasive sense of a kind of fuzziness, or lack of clarity, or somehow their brains just were not working the way that they were before.
Dr. Cindy Carter: It is a common complaint among people who have gone through chemotherapy treatment. I think that we really just have a lot more work to do there in understanding what these changes may actually be. Is there a difference between actual changes in cognitive functioning? The perceived effects for some people may be more important than they are for other people.
Dr. Linda Austin: What recommendation do you have for folks who are suffering either with depression or anxiety, or a sense of isolation or even chemo brain? What would you suggest they do?
Dr. Cindy Carter: There is a growing number of resources available now. Certainly, we have come a long way in understanding these issues of survivorship. The National Cancer Institute now has an office of Cancer Survivorship. They are a wonderful resource for people who are interested in learning more specifically about chemo brain, or concerns about depression and anxiety at a national level. But, of course, here, at a statewide and local level, there are a number of resources available, including the American Cancer Society, the Hollings Cancer Center website, and other organizations in town that can help people get, really, to the professional that they need to see, whether that is a licensed clinical psychologist, such as myself, or a support group, or a psychiatrist, and an opportunity to use pharmacological interventions as well as talking with people and developing some skills for coping with what can be the most challenging event in a person’s life.
Dr. Linda Austin: Dr. Carter, thank you so much.
Dr. Cindy Carter: Thank you.
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