There is a great article in today's NYTimes on Chemo Brain.
Once, women complaining of a constellation of symptoms after undergoing chemotherapy — including short-term memory loss, an inability to concentrate, difficulty retrieving words, trouble with multitasking and an overarching sense that they had lost their mental edge — were often sent home with a patronizing “There, there.”
But attitudes are changing as a result of a flurry of research and new attention to the after-effects of life-saving treatment. There is now widespread acknowledgment that patients with cognitive symptoms are not imagining things, and a growing number of oncologists are rushing to offer remedies, including stimulants commonly used for attention-deficit disorder and acupuncture.
I spoke about chemo brain a few months ago, and, in a way, have been lucky that my oncologist had also suffered from chemo brain, and was thus a little more understanding towards my own frustrations. In fact it was because of my chemo brain that this blog was born. But, it appears I'm even luckier as this was the one time my onc has not steered me towards another drug. (as regular readers know, I have a hard time relying on taking a pill to live) Nope, his suggestions was to work harder at the areas I felt had declined. Can't remember words, play word games (boggle, scrabble, crossword puzzels, etc.). Can't put together phrases, write more. Can't grasp an idea, read more and write short synopsis.
Virtually all cancer survivors who have had toxic treatments like chemotherapy experience short-term memory loss and difficulty concentrating during and shortly afterward, experts say. But a vast majority improve. About 15 percent, or roughly 360,000 of the nation’s 2.4 million female breast cancer survivors, the group that has dominated research on cognitive side effects, remain distracted years later, according to some experts. And nobody knows what distinguishes this 15 percent.
Most oncologists agree that the culprits include very high doses of chemotherapy, like those in anticipation of a bone marrow transplant; the combination of chemotherapy and supplementary hormonal treatments, like tamoxifen or aromatase inhibitors that lower the amount of estrogen in women who have cancers fueled by female hormones; and early-onset cancer that catapults women in their 30s and 40s into menopause.
Well, this is indeed interesting. Based on this, my personal fight with chemo brain will continue for a long time to come as I am part of the last two "culprits."
But, this article brings up something else. The economic factor.
Dr. Fleishman and others were pressed as to why a poor woman, working several jobs to feed her children, navigating the health care system and battling insurance companies, would not also need mental dexterity. “Maybe we’re just not asking them,” Dr. Fleishman said.
Overall, middle-class cancer patients tend to get more aggressive treatment, participate in support groups, enroll in studies and use the Internet for research and community more than poor and minority patients, experts say.
“The disparity plays out in all kinds of ways,” said Ellen Coleman, the associate executive director of CancerCare, which provides free support services. “They don’t approach their health care person because they don’t expect help.”
Well, I'm wondering why no one is saying that there are poor women that are not getting treatment at all. A few days ago, Komen released a report on Breast Cancer Mortality Rate. (thanks to Spiidey who sent me this link.) Now, before I go further, I have a love-hate relationship with Komen. I view them much like I view the American Cancer Society. Organizations that are well meaning in raising awareness and helping get out information, but have been coopted by corporate interests.
But, Komen did fight to reauthorize the National Breast and Cervical Cancer Early Detection Act last year, that Bush tried to gut. It as another one of Bush's let women die attempts. And, thankfully it failed, like the massive failure he (and his administration) has been. It is also this program, and it's sister program, the National Breast and Cervical Cancer Prevention and Treatment Act, that I will fight tooth and nail to make sure they survive. I have a personal interest that these programs don't fail, because it is this program that has offered me treatment.
But, these programs aren't saving many lives, at least not according to the Komen report. In fact, we find that the NBCCPT Act is being used to deny women treatment.
The report reveals shocking racial disparities in breast cancer mortality rates, tremendous barriers that prevent low-income women from receiving care, and disturbing gaps in the implementation of the Breast and Cervical Cancer Treatment Act that enable states to refuse treatment for women based on where they are screened.
This is absolutely unacceptable!
These disparities are not limited to the eight communities this report focused on. These disparities are nationwide. In fact, when I had my first appointment with DHS, my caseworker was the only person of all the other caseworkers in that office that had previously filled out the BCCT paperwork in this area. She told me, at that time, that DHS, here in Knoxville, got very few women applying for the program, much less eligible women. At the time it didn't surprise me, as the CDC information I had found after my diagnosis (but before treatment) stated the program reached only 12-15% of eligible women nationally. That was almost 4 years ago.
But, let's take note of Tennessee's own Breast and Cervical Cancer Screening Program. (this is the screening program as opposed to the treatment program).
These guidelines change each year. For more information, call the Tennessee Breast and Cervical Screening Program at 1-877-96-WOMEN (1-877-969-6636) or the National Cancer Institute at 1-800-4-CANCER (1-800-422-6237).
"These guidelines change each year." I am assuming this statement is for the income levels (which I must note went from 150% of the federal poverty level 4 years ago to 250%). I will give TN the kudos they deserve for upping the income levels to cover more women. Also, TN deserves kudos when state implemented their BCCP programs, they opted to choose all three options that would cover women's preventative screenings.
However, when I took a look at TN annual report on cancer (1997-2003) (pdf), the mortality rate has skyrocketed from 2002 to 2003. (figure 24, page 54). If we look at race, black women in TN have a higher mortality rate than white women (figure 27, page 56). But, there is nothing on income and insurance disparities in that report.
As it is becoming more and more obvious that income also has an impact on how a woman with breast cancer is medically treated, states must take the initiative to make sure these women are not turned aside, because, we are increasingly finding that insurance companies are no longer covering the cost of preventative screening. We must look at how many of these women that are dying of breast cancer are dying needlessly. Are they being covered, either by insurance, medicaid, medicare, or the extended medicaid through the NBCCPTA?
As I am fond of saying, the bottom line is, there is no acceptable reason a woman should not be able to get preventative screening for breast cancer, and there is no acceptable reason a woman with breast cancer should not be able to get treatment, and not just haphazard treatment, but quality treatment.