Skip to main content
SpringerLink
Log in

The perceptions of Australian oncologists about cognitive changes in cancer survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

Cancer-related cognitive changes (CRCC) can have a profound impact on a cancer survivor’s quality of life. However, cancer survivors frequently report receiving limited information about their experience of CRCC from their oncology specialists. This qualitative study aimed to explore the perceptions of oncology specialists regarding CRCC and the potential for their views to influence their decisions about patient care.

Methods

Thirteen medical oncologists and five radiation oncologists currently practising in Australia participated in this study. Data collection involved individual semi-structured interviews via telephone. Data were audio-recorded, transcribed verbatim and analysed using a thematic approach.

Results

Four key themes emerged: (1) beliefs about the impact of priming on cancer survivors’ perceived cognitive function, (2) perceptions of who is more likely to raise concerns of cognitive change, (3) uncertainty of how to best manage CRCC, and (4) the perceived role of oncologists in the management of CRCC.

Conclusions

CRCC and its impact on the cancer survivor’s journey have been under-addressed by oncology specialists, and they are uncertain of potential management strategies. With cancer survival rates increasing, there is a need for specific interventions and management guidelines addressing CRCC and their effects on cancer survivors. Future exploration should focus on the survivor as central to their care and holistic approaches to CRCC management involving all members of the multidisciplinary team.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. AIHW & AACR (2012) Cancer in Australia 2012: an overview. AIHW, Canberra

    Google Scholar 

  2. Cheung WY, Neville BA, Cameron DB, Cook EF, Earle CC (2009) Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol 27:2489–2495. doi:10.1200/JCO.2008.20.3232

    Article  PubMed  Google Scholar 

  3. Mao JJ, Bowman MA, Stricker CT et al (2009) Delivery of survivorship care by primary care physicians: the perspective of breast cancer patients. J Clin Oncol 27:933–938. doi:10.1200/JCO.2008.18.0679

    Article  PubMed  Google Scholar 

  4. Nissen MJ, Beran MS, Lee MW, Mehta SR, Pine DA, Swenson KK (2007) Views of primary care providers on follow-up care of cancer patients. Fam Med 39:477–482

    PubMed  Google Scholar 

  5. Hewitt M, Greenfield S, Stovall E (2005) From cancer patient to cancer survivor: lost in transition. National Academic Press, Washington DC

    Google Scholar 

  6. Vardy J, Wefel JS, Ahles T, Tannock IF, Schagen SB (2008) Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop. Ann Oncol 19:623–629. doi:10.1093/annonc/mdm500

    Article  CAS  PubMed  Google Scholar 

  7. Mehnert A, Scherwath A, Schirmer L et al (2007) The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Educ Couns 66:108–118. doi:10.1016/j.pec.2006.11.005

    Article  PubMed  Google Scholar 

  8. Selamat MH, Loh SY, Mackenzie L, Vardy J (2014) Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications. Plos Med 9:e108002. doi:10.1371/journal.pone.0108002

    Article  Google Scholar 

  9. Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP (2011) Either called “Chemobrain” or “Chemofog”, the long-term chemotherapy- induced cognitive decline in cancer survivors is real. J Pain Symptom Manag 41:126–139. doi:10.1016/j.jpainsymman.2010.04.021

    Article  Google Scholar 

  10. McAllister TW, Ahles TA, Saykin AJ et al (2004) Cognitive effects of cytotoxic cancer chemotherapy: predisposing risk factors and potential treatments. Curr Psychiatry Rep 6:364–371. doi:10.1007/s11920-004-0023-y

    Article  PubMed  Google Scholar 

  11. Hermelink K, Untch M, Lux MP et al (2007) Cognitive function during neoadjuvant chemotherapy for breast cancer: results of a prospective, multicenter, longitudinal study. Cancer 109:1905–1913. doi:10.1002/cncr.22610

    Article  CAS  PubMed  Google Scholar 

  12. Vardy J, Booth C, Pond GR et al (2007) Cytokine levels in patients (pts) with colorectal cancer and breast cancer and their relationship to fatigue and cognitive function. J Clin Oncol 25:9070

    Article  Google Scholar 

  13. Ahles TA, Saykin AJ (2007) Candidate mechanisms for chemotherapy-induced cognitive changes. Nat Rev Cancer 7:192–201. doi:10.1038/nrc2073

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Jansen CE, Cooper BA, Dodd MJ, Miaskowski CA (2011) A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients. Support Care Cancer 19:1647–1656. doi:10.1007/s00520-010-0997-4

    Article  PubMed  Google Scholar 

  15. Biglia N, Bounous VE, Malabaila A et al (2012) Objective and self-reported cognitive dysfunction in breast cancer women treated with chemotherapy: a prospective study. Eur J Cancer Care 21:485–492. doi:10.1111/j.1365-2354.2011.01320.x

    Article  CAS  Google Scholar 

  16. Mitchell T, Turton P (2011) ‘Chemobrain’: concentration and memory effects in people receiving chemotherapy – a descriptive phenomenological study. Eur J Cancer Care 20:539–548. doi:10.1111/j.1365-2354.2011.01244.x

    Article  CAS  Google Scholar 

  17. Boykoff N, Moieni M, Subramanian SK (2009) Confronting chemobrain: an in-depth look at survivors’ reports of impact on work, social networks, and health care response. J Cancer Surviv 3:223–232. doi:10.1007/s11764-009-0098-x

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cheung YT, Shwe M, Tan EHJ, Chui WK, Ng R, Chan A (2013) Acknowledging the relevance of cognitive changes in cancer patients: perspectives of oncology practitioners in Asia. J Cancer Surviv 7:146–154. doi:10.1007/s11764-012-0256-4

    Article  PubMed  Google Scholar 

  19. Munir F, Kalawsky K, Lawrence C, Yarker J, Haslam C, Ahmed S (2011) Cognitive intervention for breast cancer patients undergoing adjuvant chemotherapy: a needs analysis. Cancer Nurs 34:385–392. doi:10.1097/NCC.0b013e31820254f3

    Article  PubMed  Google Scholar 

  20. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3:77–101. doi:10.1191/1478088706qp063oa

    Article  Google Scholar 

  21. Aitken C, Power R, Dwyer R (2008) A very low response rate in an on‐line survey of medical practitioners. Aust NZ J Public Health 32:288–289. doi:10.1111/j.1753-6405.2008.00232.x

    Article  Google Scholar 

  22. Brinkmann S (2013) Qualitative interviewing. Oxford University Press, Oxford

    Book  Google Scholar 

  23. Curtin M, Fossey E (2007) Appraising the trustworthiness of qualitative studies: guidelines for occupational therapists. Aust Occup Ther J 54:88–94. doi:10.1111/j.1440-1630.2007.00661.x

    Article  Google Scholar 

  24. Jiwa M, Packer TL, Merriman G et al (2008) Timely cancer diagnosis and management as a chronic condition: opportunities for primary care. Med J Aust 189:78–82

    PubMed  Google Scholar 

  25. McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling L, Lorig K, Wagner E (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 61:50–62. doi:10.3322/caac.20093

    Article  PubMed  PubMed Central  Google Scholar 

  26. Phillips JL, Currow DC (2010) Cancer as a chronic disease. Collegian 17:47–50. doi:10.1016/j.colegn.2010.04.007

    Article  PubMed  Google Scholar 

  27. Epstein R, Street RL (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute, Bethesda

    Google Scholar 

  28. Olver I, Whitford H, Denson L, Peterson M, Olver S (2009) Improving informed consent to chemotherapy: a randomized controlled trial of written information versus an interactive multi-media CD-ROM. Patient Educ Couns 74:197–204. doi:10.1016/j.pec.2008.08.021

    Article  PubMed  Google Scholar 

  29. Friedman A, Cosby R, Boyko S, Hatton-Bauer J, Turnbull G (2011) Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations. J Cancer Educ 26:12–21. doi:10.1007/s13187-010-0183-x

    Article  PubMed  Google Scholar 

  30. Schagen SB, Das E, van Dam FS (2009) The influence of priming and pre-existing knowledge of chemotherapy-associated cognitive complaints on the reporting of such complaints in breast cancer patients. Psycho-Oncology 18:674–678. doi:10.1002/pon.1454

    Article  PubMed  Google Scholar 

  31. Skaali T, Fossa SD, Andersson S et al (2011) Self-reported cognitive problems in testicular cancer patients: relation to neuropsychological performance, fatigue, and psychological distress. J Psychosom Res 70:403–410. doi:10.1016/j.jpsychores.2010.12.004

    Article  PubMed  Google Scholar 

  32. Duijts SFA, van Egmond MP, Spelten E, van Muijen P, Anema JR, van der Beek AJ (2014) Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review. Psycho-Oncology 23:481–492. doi:10.1002/pon.3467

    Article  PubMed  Google Scholar 

  33. Bradley CJ, Neumark D, Bednarek HL, Schenk M (2005) Short-term effects of breast cancer on labor market attachment: results from a longitudinal study. J Health Econ 24:137–160. doi:10.1016/j.jhealeco.2004.07.003

    Article  PubMed  Google Scholar 

  34. Player L, Mackenzie L, Willis K, Loh SY (2014) Women’s experiences of cognitive changes or ‘chemobrain’ following treatment for breast cancer: A role for occupational therapy? Aust Occup Ther J 61:230–240. doi:10.1111/1440-1630.12113

    Article  PubMed  Google Scholar 

  35. Myers JS (2012) Chemotherapy-related cognitive impairment: the breast cancer experience. Oncol Nurs Forum 39:31–40. doi:10.1188/12.onf.e31-e40

    Article  Google Scholar 

  36. Reid-Arndt SA, Yee A, Perry MC, Hsieh C (2009) Cognitive and psychological factors associated with early posttreatment functional outcomes in breast cancer survivors. J Psychosoc Oncol 27:415–434. doi:10.1080/07347330903183117

    Article  PubMed  PubMed Central  Google Scholar 

  37. Fleissig A, Jenkins V, Catt S, Fallowfield L (2006) Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol 7:935–943. doi:10.1016/S1470-2045(06)70940-8

    Article  PubMed  Google Scholar 

  38. Schuurs A, Green HJ (2013) A feasibility study of group cognitive rehabilitation for cancer survivors: enhancing cognitive function and quality of life. Psycho-Oncology 22:1043–1049. doi:10.1002/pon.3102

    Article  PubMed  Google Scholar 

  39. Newman R, Campbell C (2013) An occupational therapy perspective in addressing breast cancer-related cognitive dysfunction in the survivorship phase. Phys Disabil Spec Interest Section Q Am Occup Ther Assoc 36:1–3

    Google Scholar 

Download references

Acknowledgments

The authors thank the participating oncology specialists for sharing their time, thoughts and experiences.

Author information

Authors and Affiliations

  1. Orange Health Service, Bloomfield, NSW, 2800, Australia

    Kate Smidt

  2. Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia

    Lynette Mackenzie & Joanne Lewis

  3. Faculty of Medicine, Central Clinical School, University of Sydney, Sydney, NSW, 2006, Australia

    Haryana Dhillon

  4. Faculty of Medicine, Concord Clinical School, University of Sydney, Sydney, NSW, 2006, Australia

    Janette Vardy

  5. Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Siew Yim Loh

Authors
  1. Kate Smidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynette Mackenzie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haryana Dhillon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janette Vardy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joanne Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Siew Yim Loh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lynette Mackenzie.

Ethics declarations

Ethics approval was obtained from the Human Research Ethics Committee at the University of Sydney, Australia (reference no. 2014/323).

Conflict of interest

The authors have no conflict of interest to declare in relation to this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smidt, K., Mackenzie, L., Dhillon, H. et al. The perceptions of Australian oncologists about cognitive changes in cancer survivors. Support Care Cancer 24, 4679–4687 (2016). https://doi.org/10.1007/s00520-016-3315-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3315-y

Keywords

Search

Navigation