It’s Breast Cancer Awareness Month, a time to rally behind breast cancer patients and survivors. But beyond signing up for a 5k run or buying pink ribbon earrings, this year we need to make sure breast cancer survivors have a fighting chance as they strive to get back to a new “normal” in their work lives.
One of the most debilitating side effects many breast cancer survivors experience is cognitive impairment, often referred to as “chemobrain” and attributed to the mental fogginess from chemotherapy. Although the cause of cognitive impairment in cancer survivors is not fully known, recent studies have found that chemotherapy may be one of many possible culprits.
But whatever the cause, the problem is real. It’s time for all of us — especially employers and health care providers — to acknowledge that cognitive impairment is as real and potentially devastating as any other symptom or side effect. And it’s time for supervisors to make reasonable accommodations, as mandated by federal legislation.
Cognitive impairment does not have a ready fix. Health care providers focus on the nausea, diarrhea and fevers, but cognitive impairment is rarely mentioned mostly because there is no clear pharmaceutical remedy. Cancer survivors are left to deal with these cognitive problems on their own.
According to various studies, between 20 and 75 percent of survivors report difficulty with memory, concentration and other mental functions to the point that their work suffers. Tasks that were once routine have become difficult. Memories are not quite as sharp. And supervisors who were sympathetic when they heard about their employee’s diagnosis are now growing annoyed that work is late or not up to par. Because no one told them about this possibility, many survivors think they must be going crazy.
The mental fogginess can be so severe that many breast cancer survivors decide to retire earlier than planned or work fewer hours, which can dramatically affect their earning power. According to the Livestrong Foundation, 55 percent of cancer survivors worry they will be forced to retire or quit before they are ready, and one-third decide not to pursue an advancement or promotion fearing they are not up to the job.
These percentages are too high. Instead of allowing survivors to go it alone, it’s time for health care providers and workplaces to understand that a survivor’s cancer experience is not over just because treatment is finished.
For health care providers, many survivors say that simply having their physician validate their mental state is a relief. Breast cancer protocols should include cognitive impairment as a symptom and side effect, and providers should be ready to discuss cognitive changes at the time of diagnosis, during treatment and afterward. Or they could refer survivors to neuropsychologists or occupational therapists, who can provide coping and improvement strategies. Research teaching survivors how to improve their cognitive abilities is also showing positive results, and health care providers should give information about these studies.
For employers, cancer side effects are covered under the Americans with Disabilities Act, which requires employers to provide reasonable accommodations to employees with disabilities. Supervisors should understand that although breast cancer survivors may experience a variety of prolonged side effects for an indefinite time, they are still able to perform. Supervisors should therefore be prepared to work with an employee to come up with a plan that lessens the effects of the impairment on work.
For instance, if the survivor is struggling with attentiveness, he or she could be given an office with a door to shut or a cubicle away from busy corridors. Co-workers can be enlisted to double check assignments for accuracy. Deadlines could be extended, and employees could be encouraged to ignore email notifications or phone interruptions when working on cognitively demanding tasks.
As we mark Breast Cancer Awareness Month, we should offer more support at the time of diagnosis and through treatment, but because side effects such as cognitive impairment are devastating and may linger, we should ensure that survivors have every opportunity to remain productive once they finish active treatment. We can do more for cancer patients and survivors when it comes to dealing with chemobrain.
Heather Becker is research scientist in the School of Nursing at The University of Texas at Austin School of Nursing and is a member of the Cancer Alliance of Texas.
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— Texas Perspectives (@TexPerspectives) October 15, 2015