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Diagnosis and PTSD and Cognition

Posted 4/21/2015

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  I have to admit that it delights me when there is a research study that confirms what I have already long known and tried to teach other people. On the flip side, one might reasonably ask why, if I am so smart, I didn't do the research. Fair question.

   A recently released study from Munich, and published in the Journal of the NCI, indicates that women who are newly diagnosed with breast cancer (and I am 110% certain that this applies to everyone who is diagnosed with any kind of cancer) experience a period of cognitive impairment that is related to the trauma of the diagnosis. Since crisis theory informs us that no one can stay in a high state of anxiety and crisis indefinitely (the usual figure discussed is 6-8 weeks), we know that women gradually return to their pre-diagnosis state of functioning. This would generally coincide with the time it takes to go through tests and staging and initial medical appointments and, probably, surgery and develop a treatment plan. I always reassure newly diagnosed people that this period is as bad as it emotionally gets, and that they will feel better once all the information is gathered, and a plan is designed.

  Not infrequently, I have calls or even pages from a physician who is overwhelmed by a distraught newly diagnosed patient. The message to me is: "Help, come do something." The first thing I do is remind the doctor that this distress is not the person's baseline, and then come to reassure the patient of the same thing. Some people are so agitated and upset that it is close to impossible for them to think straight and settle down. Only time helps.

  It is important to remember that it is this early period after diagnosis when people are asked to make many difficult choices and decisions. It is really hard to take in and process complicated medical information, sometimes conflicting advice, and to make choices that will impact the rest of one's life while in this state of high anxiety and diminished cognitive capacity. Here is where it is especially important to have supportive people nearby and some time to consider the options.

  Here is the beginning and a link to a summary from Eureka Health:

Cancer and chemobrain: Cancer diagnosis affects cognitive function
Breast cancer patients often display mild cognitive defects even before the initiation of chemotherapy. A new
study by Ludwig-Maximilians-Universitaet (LMU) in Munich researchers now attributes the syndrome to
post-traumatic stress induced by diagnosis of the disease.
A large number of studies have shown that cancer patients very often exhibit mild deficits of attention,
memory and other basic cognitive functions. The phenomenon has generally been attributed to putative
side-effects of chemotherapeutic drugs on the brain, and the condition is therefore popularly referred to as
chemobrain. - However, more recent investigations have detected symptoms of chemobrain in patients who
had not yet embarked on a course of chemotherapy. Now a research team led by LMU's Dr. Kerstin Hermelink at the Breast Center in the Department of Gynecology and Obstetrics at Munich University Hospital has shown that, in breast cancer patients, pretreatment cognitive impairment is most probably due to posttraumatic stress induced by diagnosis of the malignancy itself. The group's findings have just appeared in the Journal ofthe National Cancer Institute.

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