Cancer treatment is so multi-faceted – lots of moving parts, lots of appointments, scans, doctors, and therapies go into treating and managing all types of cancer. It is very overwhelming to say the least, and it sometimes can feel like you are losing your mind due to sheer number of tasks you must accomplish to keep managing your disease in check. Part of that feeling may be due to something called ‘chemo brain’.
What is ‘Chemo Brain’?
According to the Mayo Clinic (www.mayoclinic.org ), “chemo brain is a common term used by cancer survivors to describe thinking and memory problems that can occur during and after cancer treatment. Chemo brain can also be called chemo fog, cancer-related cognitive impairment, or cognitive dysfunction.” It’s important to note that “chemo brain” is not just limited to those people with brain related cancers. It can affect anyone who is currently undergoing chemotherapy, as well as those who are receiving radiation, bone marrow transplant, immunotherapy, and targeted drug therapy. We need to remember that cancer is a systemic issue, meaning it affects all parts of your body and not just the cancer part. Specific types of chemotherapy drugs used in fighting different types of brain cancers can cross the blood brain barrier (BBB) although there are not many that do so. Per the National Cancer Institute (www.cancer.gov), the blood brain barrier is “a network of blood vessels and tissue that is made up of closely spaced cells and helps keep harmful substances from reaching the brain. The blood-brain barrier lets some substances, such as water, oxygen, carbon dioxide, and general anesthetics, pass into the brain. It also keeps out bacteria and other substances, such as many anticancer drugs.”
How common is chemo brain?
Studies have estimated that 67% of people receiving chemotherapy have reported some type of cognitive problem – so more than half! Women are more at risk then men and genetic differences may also increase your risk of developing chemo brain. For most people, chemo brain symptoms resolve themselves 9-12 months following the end of chemotherapy treatment. Approximately 10-20% of people have chemo brain symptoms persisting beyond 12 months, and some even report symptoms 10 years post treatment. These symptoms should be considered stable, meaning unchanging. If they are worsening it could indicate a larger underlying problem.
What are the symptoms of chemo brain?
The most common symptoms of chemo brain include decreased short-term memory, decreased attention span, increased difficulty word finding, and trouble with multi-tasking. Per Dr. Arash Asher, who is the director of Cancer Rehabilitation and Survivorship at Cedars-Sinai (www.cedars-sinai.org), “Chemo brain is not dementia. And there is no evidence that it leads to dementia.” That is a very important item to remember if someone is experiencing these types of symptoms – decreased memory does not automatically equal dementia! A good way to monitor your symptoms when you first start to notice them is to keep a journal. That can sound counterintuitive at first. Almost like “How am I supposed to remember when I cannot remember?!” The short answer is – Do the best you can! Keep a notepad nearby and make note when you cannot think of a word, or cannot recall if you completed a basic household task. The idea is not to keep a detailed log, but just to generally have an idea what types of issues you are having. The more information you can provide your physician, the better! You physician may refer you to a neuropsychologist for a detailed cognitive assessment, but more often than not, it will probably be recommended that you manage your difficulties without that type of intervention.
How can chemo brain be managed?
Management is going to be dependent on your symptoms (which is why journaling is so important!). As previously mentioned, the most common symptoms of chemo brain include decreased short-term memory, decreased attention span, increased difficulty word finding, and trouble with multi-tasking. Here are some suggestions as to how to manage the most common symptoms of chemo brain:
Decreased Short Term Memory:
Get yourself a planner or datebook! Having a planner can be helpful when remembering items like appointments, birthdays, anniversaries, and holidays. It is not realistic to expect yourself to be able to keep all of the items you need to do for the next few weeks solely in your mind. Some people like the feeling of writing items down, and crossing items off a ‘to do’ list as they are accomplished, while others prefer to use apps in their smartphones – it is all dependent on your personal preference. One is not better or more effective than the other is. The only caveat is that you have to consistently put the information you need to remember in the planner or app – it unfortunately is not transferred by osmosis or telepathically. If you yourself are having trouble doing so, call on a friend or family member to assist you. Once you get into a good routine you should be able to make using your planner or app a habit. Also hanging up visual aids around your home can be helpful for things such as remember to take your wallet, purse, or phone with you before leaving your house. There are many different types of fashionable letter boards out now at a good price so your memory aides can match your home décor!
Decreased Attention Span:
Work in a quiet environment when completing important tasks, and take breaks! Use a simple egg time to help avoid burn out. Set the timer for 30 minutes (or whatever you feel is good for you) and work on a task or project until that timer sounds. Once the timer sounds, get up from your workstation and take a break. That break can look like a short walk around the block, making yourself a cup of coffee or even turning on some light music. It is important you know your own limitations and do not try to push yourself too hard. The quality of your work will go down as your attention to the task decreases. Be sure to schedule important items in the morning when you have more energy and are fresher. If you wait until the end of your day to get those important things completed, fatigue is going to come into play and your attention will be even further diminished.
Difficulty Word Finding:
If you are having trouble finding the right words at times, give yourself a minute or two to think of it – take your time! Describing the item you are trying to recall is also effective and so is using a synonym (word that means the same). The most important thing you can do for yourself when you have trouble word finding is to be kind to yourself! It is very easy to fall into a negative thought pattern when having increased difficulty.
Working in a quiet environment and limiting the number of items you are working on at one time will be the best way to manage this part of the chemo brain fog. In the past, you may have been able to have three or four things going at once but in order to be successful while foggy you have to adjust – work on one or two items at time. If there are several parts to something that need to be completed at once (a recipe, large dinner) you may have to ask for assistance. Asking for help is not a sign of weakness or a bad thing to do – it shows you have good insight into your abilities and want what you are currently working on to be of good quality.
It is important to keep in mind that the chemo brain fog will not last forever.
Yes, it is true that some people experience things associated with chemo brain for quite a while but overall most symptoms resolve themselves once your treatment is completed. Doing things to compensate for the trouble you are having will help you be successful navigating your chemo brain fog. Listening to your body is incredibly important throughout the recovery process. Nontraditional treatments may help you navigate chemo brain dog as well. Do not discount things like mindfulness, meditation, and yoga – there is wonderful research to suggest that these items can help improve overall cognitive functioning and thinking skills. Per an article published in the Journal of Cancer Survivorship in 2015, “participation in a mindfulness-based stress reduction program yields robust and sustained improvement in cancer-related cognitive impairment, a prevalent and potentially debilitating condition that affects attention, memory and executive function in survivors, according to a new study.” You can find a link to the study referenced here.
As stated earlier, cancer treatment is multifaceted. Keep in mind that recovering is also multifaceted, and has just as many moving parts as treatment. Be kind to yourself, and readily accept help from those who are willing to offer it. Recovery is a process, and it truly takes a village.
To find out more about caring for the person with cancer, check out our jam-packed, practical, and compassionate webinar, Cancer Care: A Collaborative Approach! This short but powerful webinar is sure to give your practice the boost it needs!
Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves 🙂