• This Is Why

    Lifting the Fog

    Enlisting physical therapy in the fight against "chemo brain."

    • By Deborah Doherty, PT, PhD, CEAS
    • July 2012

    Podcast: Listen to 'This Is Why'
     

    I have been a breast cancer survivor since 2006. The "Big C" led me through an intricate maze of physical and emotional hurdles and difficult decisions. This incredible journey also, however, propelled my professional career in a deeply satisfying and fulfilling direction,one I could not otherwise have envisioned.

    My 27 years as a physical therapist (PT) before my diagnosis had been joyful ones, but after surgery a new chapter began to unfold. Seeking an optimal quality of life post-mastectomy, I elected to rehab myself. I asked 2 colleagues,a PT and a physical therapist assistant,to help me address musculoskeletal deficits that had arisen during healing. I emerged from that experience determined to learn more about oncology rehabilitation. I wanted to help other women through the craziness and past the treatment barriers they would face as cancer survivors.

    Six years later, an oncology rehabilitation program I developed is in place at St Mary's of Michigan medical center, where I treat survivors of breast and prostate cancer and am involved in developing a lung cancer rehabilitation program. I'm working, as well, with Jackie Drouin, PT, PhD, of Oakland University to develop what will be the first oncology rehabilitation certification program for PTs nationally or internationally.

    One of the most devastating side effects of cancer treatment is "chemo brain",mental fogginess associated with chemotherapy that includes problems with memory, language skills, and concentration. Chemo brain can be so frustrating that those experiencing it may feel diminished confidence in their work, avoid social interactions, experience depression and anger, and even question their sanity. Until recently, however, physicians were reluctant to accept chemo brain as a "real" diagnosis,instead attributing its manifestations to stress, fatigue, insomnia, hormonal changes, and other factors. Fortunately, new studies have identified physiological changes in the brain that are caused by chemotherapy,at last giving this cognitive dysfunction the respect it deserves.

    So, now what? I have the good fortune of being associated professionally with both St Mary's of Michigan and Oakland University. A St Mary's colleague, oncologist Ernie Balcueva, MD, is deeply engaged in multiple studies related to treatment interventions for cancer survivors. He and I were frustrated by the lack of research in treatment of chemo brain, so we decided to do something about it.

    We received institutional review board approval from St Mary's and Oakland to initiate a pilot study involving 4 groups of 10 breast cancer survivors. We will use exercise (known to improve cognitive function) and the drug donepezil (known to address cognitive dysfunction in patients with Alzheimer disease, multiple sclerosis, and traumatic brain injury) to treat chemo brain in breast cancer survivors. Groups of women will take the drug, exercise 3 times per week, do both things, or serve as the control unit. This 12-week intervention will be the first of its kind. Anecdotally, some physicians are addressing chemo brain, employing a variety of interventions, but there is no standard of practice.

    We hope to change that.

    I've been asked when I'm going to retire. "There's too much to do to retire now," I respond. I see more opportunities than ever to expand physical therapy's reach into areas where rehabilitation has not historically been considered a prudent or reliable intervention. There are roughly 12 million cancer survivors in the United States, according to the Centers for Disease Control and Prevention. Their optimal quality of life is at stake, and there is no weapon more powerful than rehabilitation in the war against cancer treatment's debilitating side effects. We must wield it.

    Doherty, Deborah 75x110 

    Deborah Doherty, PT, PhD, CEAS, is an assistant professor in the physical therapy program at Oakland University in Rochester, Michigan, and an oncology rehabilitation specialist at St Mary's of Michigan medical center, based in Saginaw.  

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