2. Case Presentation
tumor, cognitive impairment, neuropathy, memory difficulties, cancer, cognitive difficulties, left breast cancer
TUMOR, INVASIVE DUCTAL CARCINOMA, BREAST CANCER, CANCER, NEUROPATHY, AIDS, METASTATIC DISEASE, SENTINEL LYMPH NODE
We obtained the consent of a 58-year-old right-handed white woman diagnosed 7 years prior with left breast cancer. She underwent partial mastectomy with sentinel lymph node biopsy and was found to have a 1 cm, grade III invasive ductal carcinoma with one out of four sentinel lymph nodes positive for cancer. The tumor was hormone receptor positive and human epidermal growth factor receptor 2 negative. Computed tomography and a bone scan were negative for distant metastatic disease. She then received four cycles of adjuvant chemotherapy with docetaxel and cyclophosphamide, followed by radiation therapy. Afterwards, she was started on adjuvant tamoxifen as she was premenopausal at diagnosis. She was on tamoxifen for 4 years, and then switched to aromatase inhibitors. Anastrozole was tried initially, but later a switch was made to letrozole, which continued to be the treatment at the time of her consenting to our study. Her only other medication was citalopram for sleep and stress, which she had been taking stably in the long term since before her treatment for breast cancer. The patient described how her “brain fog” started during chemotherapy and severely impaired her quality of life for an additional two years. She had no neuropathy or any other lasting side effects from her chemotherapy. In the third year after chemotherapy, her chemotherapy-related cognitive impairment partially cleared to stabilize to the level at the time of presentation for this study. The patient continues to have memory difficulties and decreased concentration, which makes multi-tasking very difficult to impossible. She is reliant on memory aids at work and has passed up opportunities for promotion, given her cognitive difficulties. At home, she is also reliant on memory aids and family members know that she is forgetful and ask her to write things down to remind herself.