title: Chemobrain experienced by breast cancer survivors: a meta-ethnography study investigating research and care implications.
abstract: BACKGROUND
  Cognitive impairment, colloquially termed "chemobrain", occurs in 10-40% of all cancer patients, and is an emerging target of cancer survivorship research.
  
  
  OBJECTIVE
  This study reviews published qualitative studies to explore cognitive impairments or chemobrain among breast cancer survivors, with particular attention given to the impact on quality of life.
  
  
  METHODS
  Using keywords, we searched ten electronic databases (CINAHL, EMBASE, Proquest, OVID SP, MEDLINE, Oxford Journal, Science Direct, PubMED).
  
  
  RESULTS
  Of 457 papers, seven relevant papers were included. Data was extracted and concepts were analysed using a meta ethnography approach. Four second order intepretations were identified, on the basis of which, four third order intrepretations were constructed. Linked together in a line of argument, was a consistent account on their struggles to self-manage the chemobrain impairments that impact their daily lives. Five concepts emerged from the analysis of the primary findings: i) real experiences of cognitive changes, ii) calls for help, iii) impact of cognitive impairments, iv) coping and v) survivorship and meaning. Further synthesis resulted in four new order intepretations: i) The chemobrain struggle, ii) The substantial impact of chemobrain on life domains, iii) The struggle to readjust and to self manage, and iv) 'thankful yet fearful' representation.
  
  
  CONCLUSIONS
  Awareness of cognitive changes were context-dependent on healthcare settings and cultural contexts as strong determinants. Subjects verified the existence of chemobrain but healthcare providers mis-recognised, under-recognised, and sometimes negated it perhaps due to its unknown aetiology. Asian breast cancer survivors appear less vocal than their western counterparts.
  
  
  CONCLUSIONS
  The current literature on the lived experiences of how women experienced chemobrain provides a consistent report that chemobrain is real, persistent and with detrimental impacts on quality of life - manifested as a constant struggles. A greater awareness of the effects of chemobrain with improved functional assessment and interventions is warranted.
authors.affiliation: Department of Postgraduate Studies, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Maryam Hafsah
authors.initials: MH
authors.lastname: Selamat
authors.affiliation: Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: Siew Yim
authors.initials: SY
authors.lastname: Loh
authors.affiliation: Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors.forename: Lynette
authors.initials: L
authors.lastname: Mackenzie
authors.affiliation: Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.
authors.forename: Janette
authors.initials: J
authors.lastname: Vardy
mesh_terms: D000223:Adaptation, Psychological; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology*; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D036301:Qualitative Research; D017741:Survivors / Q000523:psychology*