Reported alcohol response postchemotherapy and awareness of side effects. Another aim of this study was to explore whether there were changes in the response to alcohol postchemotherapy among US and PR participants. When asked about taste perception, many of the cancer survivors who drink alcohol (PR 50% and US 35.7%) showed a change in their taste for alcohol postchemotherapy (Table 8). Also, 46.7% of PR survivors who reported alcohol use showed that they were more sensitive to lower doses of alcohol (Table 8). In contrast, only 28.6% of US participants reported an increased sensitivity (Table 8). Table 8 indicates that the majority (PR 93.3% and US 95.8%) of participants experienced a posttreatment decrease in the amount of alcohol they could consume without feeling its effects.
Pearson’s chi-square was used to assess the relation between alcohol responses postchemotherapy among PR and US participants. There was no significant association between groups in taste or sensitivity for lower levels of alcohol after the treatment of cancer. However, there was a significant association in the tolerance of alcohol levels after the treatment of cancer (Table 8, P , 0.001), with alcohol tolerance being lower after cancer treatment. We examined whether there was association between alcohol use and memory loss, but no significant associations were found (data not shown).
Participants in each group reported that a majority of medical professional did not talk to them about alcohol consumption during chemotherapy (PR 52.2% and US 51.5%) (Table 8). The participants reported that medical professionals asked them about alcohol consumption before, during, or postchemotherapy (PR 63.0% and 57.6%) (Table 8). Compared to US female cancer patients (36.4%), more PR participants (58.7%) wished that they had received information about how chemotherapy and other medications affect alcohol response (Table 8).
(To view a larger version of Table 8, click here.)
The results of our study are consistent with other research findings and yield new information specific to similarities and differences of experience among female cancer patients in US and PR. It is important to mention that there are no significant differences in the amounts of medications currently used to treat female cancer patients, including secondary medications during chemotherapy. A larger amount of US women perceived loss of short-term memory and reported greater difficulty in finding their direction when compared to PR women. This is in accordance with findings that give clear evidence that chemotherapy affects neurons, causing cognitive dysfunction in a large portion of survivors.12,13,16–19 Indeed, a reduction in hippocampal cell proliferation is evident following a single intravenous injection of the chemotherapy drug methotrexate in animal models,37,38 and 5-flourouracil treatment leads to encephalopathy in humans.9,12 The majority of the US participants report a diminished memory regardless of time postchemotherapy and a reduced way-finding particularly in those with greater than one year postchemotherapy, which is consistent with previous studies.11,13,39,40 Although fewer PR women report short-term memory loss and way-finding, .20% reported a decline in both. This study was limited in what type of memory loss patients were asked to report; consequently, a difference in reporting of a specific type of memory loss may not represent an actual difference in memory loss overall. One detailed study has been conducted in PR breast cancer patients suggesting only working memory and way finding where impaired postchemotherapy, both correlating with coping style.22 It is important to highlight that a significant portion of patients reported that medical professional did not discuss memory loss as a possible side effect of chemotherapy. Retrospectively, most of the PR and US participants wished that they had been given more information about how chemotherapy treatment and other medications affect memory.
Trends related to alcohol consumption are more straightforward. Both the US and PR women perceived differences in alcohol response postchemotherapy. Taste perception and sensitivity to alcohol did change in our sample as it has in other studies,41,42 despite high variability in medication use and types of alcohol consumed. Changes in taste are associated with a decreased quality of life for patients postchemotherapy, though patients who were aware of taste-related side effects of medications before beginning treatment were less likely to experience negative effects.1,41,43
Although there was no apparent increase in alcohol consumption among US participants following treatment, they consumed alcohol at a higher rate compared to PR participants. Less US participants reported wished they had received information about the potential for chemotherapy and other medications to affect alcohol response; however, this could be related to their higher rate of drinking levels prechemotherapy. PR participants had slightly increased alcohol consumption postchemotherapy.
Most participants reported that they did not receive information regarding implications of alcohol consumption, but the majority were asked by their medical providers about alcohol consumption before, during, and postchemotherapy. Although low doses of alcohol have been reported to increase appetite, reduce fatigue, and improve prognosis and likelihood of survival;30,31,44 only a few medical professionals suggested to patients that drinking a glass of wine during or after completing chemotherapy would be beneficial. In general, alcohol consumption is rarely talked about with cancer patients, possibly due to stigma or the belief suggesting that alcohol use can lead to excess drinking as a potential coping mechanism.45 Cancer diagnosis can also affect cognitive and emotional functions leading to the development of psychological distress and maladaptive coping strategies, such as excessive alcohol consumption. Excess drinking and alcohol use disorders are associated with poor prognosis and survival.25,32
Results of this study show that the major differences between PR and US participants are related to alcohol consumption rates before and after chemotherapy treatment. Reports from PR and US participants show similarities in the use of medical protocols, including secondary hormones treatments. The absence of pretreatment information from a medical professional related to alcohol consumption and decreased alcohol tolerance postchemotherapy was also consistent between groups. This suggests regardless of ethnicity that all these facts are not addressed by medical professionals as a part of recommended treatment protocols. Patients who are not educated on the potential therapeutic effects of low-dose alcohol consumption, including increased appetite, reduced fatigue, improved prognosis, and likelihood of survival, may assume that they ought to avoid alcohol and miss an opportunity to improve both their chance of survival and quality of life.
LIMITATIONS AND FUTURE STUDIES
In this study design, sample size is the major limitation that could affect results. The results should be taken as a part of a pilot study, the purpose of which was to determine whether doctors were discussing potential side effects of chemotherapy with their patients and whether patients wished that they had known more about the consequences of treatments before treatment. The majority of the participants in the sample were breast cancer patients; some participants had other types of gynecological cancers that involve different treatment regiments reducing the statistical power to associate specific treatments with side effects. Another limitation was the study design, since cross-sectional studies only consider one site finding, which could be affected by contextual or situational variables. Several participants reported that they did not remember what medications they had taken or characteristics of their diagnosis, and the lack of information makes it more difficult to determine correlations in treatment and changes in memory or alcohol response.
Furthermore, it is unclear whether participants forgot these pieces of information in the interim since chemotherapy or never had the information in the first place. Future studies will need to be more comprehensive and more homogenous to address specific treatment effects. Social desirability phenomena and cultural differences among reporting alcohol consumption could affect these results.46,47 A longitudinal study would clarify associations between the use of alcohol and survival. Future studies should include a larger sample size in order to generalize these findings. A similar study that uses the same design and questionnaires and includes a social desirability scale and stigma assessment may give additional context to the effects of cultural phenomena on the reporting of alcohol use. The addition of a clinically validated neuropsychological measure to future studies would give a more comprehensive picture of the relations among awareness of potential side effects of treatment and measures of depression, resilience, and executive function. This study could also be done with the same characteristics and design, taking in consideration other types of male and general types of cancers.