To provide an in-depth description of the experience of chemotherapy-related cognitive impairment (CRCI) for women with breast cancer and identify related information that women would find useful prior to chemotherapy and at the onset of cognitive changes. Qualitative, descriptive design. Academic breast cancer survivorship center in Kansas City, KS. 18 breast cancer survivors within 6-12 months of having completed chemotherapy who self-reported changes in cognitive function. Data were collected with a demographic questionnaire, semistructured interviews, and a focus group. Qualitative content analysis was performed. Study themes were Life With Chemobrain, How I Changed, How I Cope, and How to Teach Me. Participants described difficulty with short-term memory, focusing, word finding, reading, and driving. Issues with fatigue, trouble sleeping, neuropathy, balance, and coordination also were of concern. Coping strategies included writing things down, depending on others, focusing on one task at a time, and giving oneself permission to make mistakes. Participants described exercise and getting enough rest to be helpful and recommended activities to stimulate the mind. Participants wanted information about the potential for CRCI prior to initiating chemotherapy and desired an individualized approach to education. Specific recommendations for education were provided. The study results provide a framework for understanding the experience of CRCI that can be used to guide development of patient and family education and generate questions for additional research. Application of the study results will enhance informed consent, validate the experience of CRCI, and contribute to patient satisfaction.

To review the relationship between proinflammatory cytokine release and resultant sickness behavior; to explore the implications of sickness behavior related to depression and cancer-related symptoms. Published articles and book chapters. Proinflammatory cytokines (interleukin-1, interleukin-6, and tumor necrosis factor-alpha) are released as part of the immune response resulting in a syndrome called sickness behavior that is an adaptive and motivational reaction to disease. Sickness behavior includes lethargy, depression, anorexia, energy conservation, fever, anhedonia, cognitive impairment, hyperalgesia, and decreased social interaction. Sickness behavior is seen in patients with depression or cancer and has been described as a symptom cluster. Sickness behavior in patients with cancer may be the result of both the disease and the treatment. The related symptoms may have a profound effect on patients' quality of life. Treatment strategies that inhibit the release or activity of proinflammatory cytokines and relieve patients from symptoms of sickness behavior are being evaluated. Further research is needed to pinpoint the exact effects of specific cytokines, identify targets for therapy, and develop viable treatment strategies for preventing or minimizing the detrimental effects of cytokine-induced inflammatory responses. Sickness behavior resulting from cytokine release may provide a framework to explain many cancer-related symptoms, including depression, cognitive impairment, cachexia, fatigue, and a component of pain perception. Oncology nurses would benefit from awareness and understanding of the relationship between proinflammatory cytokine release and tissue involvement by tumors as well as some cancer-related therapies. Knowledge about the effects of cytokine release on patient behavior and the symptom experience would enhance nurses' ability to assess patients for anticipated side effects and provide appropriate education to patients and their families.

To review the effects of chemotherapeutic agents on the blood-brain barrier as related to cytokine release and cognitive impairment. PubMed database. The recent findings that standard doses of chemotherapy agents reach higher than expected levels in the brain and cerebral spinal fluid are being investigated as a potential etiology for the cognitive impairment seen in patients receiving chemotherapy for cancer. Chemotherapy and chemotherapy-related neurotoxicity are associated with the release of proinflammatory cytokines, substances related to sickness behavior (e.g., decreased ability to concentrate). Chemotherapy-related oxidative stress is an additional mechanism hypothesized to induce cognitive impairment. Cognitive impairment from chemotherapy is estimated to occur in 17%-75% of patients, and 17%-35% may suffer from long-term effects. Further research is needed to identify the patients most at risk for cognitive impairment from chemotherapy. Prospective studies that evaluate appropriate interventions and control for age, intelligence quotient, education level, hormonal status, fatigue, anxiety, depression, chemotherapy regimen, and genetic status are needed. Changes in cognitive function are associated with significant effects on patients' quality of life. Oncology nurses must be aware of chemotherapy's effects on the brain to appropriately assess and educate patients and their families. In addition, nurses should develop plans of care to prevent or manage chemotherapy-related cognitive impairment after more intervention information is obtained.

Chemotherapy-related cognitive impairment (CRCI) was first described in the 1970s, but significant recognition of CRCI did not emerge with consistency until the late 1990s. Estimates of frequency now range from 17%-75%, and evidence suggests that CRCI, or "chemobrain" as it is referred to in the lay literature, is of significant concern to patients. A variety of potentially associated factors have been identified, including age, education level, intelligence, and social support; anxiety, depression, and fatigue; disease site, stage, and comorbidities; treatment regimen, timing, duration, and concomitant therapies; and hormonal levels, cytokine levels, damage to neural progenitor cells, and the presence of the apolipoprotein E 4 allele. Controversy exists as to the most suitable neurocognitive tests to evaluate this sequeal of treatment. Neuroimaging techniques are beginning to reveal affected areas of the brain. A neuropsychologist is essential for the assessment, diagnosis, and recommendation of appropriate management strategies for this patient population. Oncology nurses should be aware of available resources, such as relevant Web sites, support groups, neuropsychologists, and cognitive retraining programs, and provide support for patients concerned about or experiencing CRCI.