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Cancer RehabilitationChemotherapySide-Effects Management

Dealing with Chemo Brain

Cognitive changes during cancer treatment, also known as “chemo brain” or “chemo fog,” are common. In fact, some studies suggest that up to 75% of patients receiving chemotherapy may face these issues.
October 2015 Vol 1 No 5
Arash Asher, MD

I am in the middle of chemotherapy, and I think I might have “chemo brain.” I feel tired, forgetful, and a bit discouraged. What is chemo brain? What is the difference between chemo brain and cancer-related fatigue? If I do have chemo brain, what can I do about it?

Cognitive changes during cancer treatment, also known as “chemo brain” or “chemo fog,” are common. In fact, some studies suggest that up to 75% of patients receiving chemotherapy may face these issues. “Chemo brain” may not be the best term to describe this problem, because many causes other than chemotherapy contribute to these common cognitive problems.

THE SYMPTOMS OF CHEMO BRAIN

Chemo brain symptoms vary from person to person, but the typical symptoms include:

  • Forgetfulness
  • Word-finding difficulties (“I have a word on the tip of my tongue and I just can’t find it”)
  • Difficulty with multitasking
  • Impaired concentration or attention
  • Short-term memory challenges (Note that old memories, problem-solving, and reasoning skills are not issues that patients typically experience with chemo brain.)

WHAT IS THE DIFFERENCE BETWEEN CANCER-BASED FATIGUE & DEPRESSION?

It is often difficult to differentiate between the symptoms of chemo brain from cancer-related fatigue and those from depression. Cancer-related fatigue affects many patients who receive cancer treatment and can involve mental and physical fatigue. The key is that unlike typical fatigue that resolves with a nap or good night’s sleep, the fatigue related to cancer and its treatment persists.

Cancer-related fatigue may worsen the symptom of chemo brain or vice versa. For example, if you are exhausted after doing some chores, it may be hard to think clearly. Or, if you are spending more energy than normal doing a cognitive task, such as balancing your checkbook, it may lead to fatigue; it is often hard to know which came first. For this reason, many researchers believe that cancer-related fatigue and chemo brain are manifestations of the same process.

Depression also shares many symptoms with cancer-related fatigue and chemo brain. Depression may lead to forgetfulness, poor concentration, fatigue, and poor sleep. So, working with your doctor to try to differentiate between the symptoms of cancer-related fatigue, chemo brain, and depression is very important for tailoring your treatment.

WHAT CAUSES CHEMO BRAIN?

  • Chemotherapy, radiation therapy, and other cancer treatments may set off chemical reactions that can affect your cognition, similar to how you may feel when you have the flu
  • Some chemotherapy drugs may pass into the brain and affect its functioning
  • Hormonal therapies that may be used for prostate or breast cancer can result in chemo brain symptoms

Many other health-related issues may contribute to cognitive problems, such as:

  • Poor sleep
  • Chronic stress
  • Taking other medications, including pain, nausea, or sleep medications
  • Poor nutrition
  • Lack of exercise or physical activity

HOW LONG DOES CHEMO BRAIN LAST?

Patients can experience chemo brain for a different duration. The good news is that the majority (approximately 75%) of cancer survivors return to their baseline cognition within 6 to 12 months after completing their treatment. However, about 33% of survivors continue to struggle with these symptoms for months or sometimes for years after treatment.

WHAT CAN I DO ABOUT CHEMO BRAIN?

Get enough sleep. The impact of inadequate sleep on cognition can’t be overstated.

Moderate exercise. Research shows the positive impact of aerobic exercise on our cognition, including research on patients with chemo brain; walking, swimming, yoga, or cycling are all helpful.

Talk to your doctor. Many of the symptoms of depression are confused with chemo brain. Treating depression, if you have it, often helps with cognition.

Optimize your nutrition. The brain seems to work best with a whole diet with fruits, vegetables, healthy fats, and protein as opposed to excessive sugar and processed foods. A nutritionist may help you develop a program that meets your needs.

Seek help from a neuropsychologist or a speech pathologist. These experts can provide you with coping strategies and new cognitive skills.

Mindfulness meditation, yoga, and other stress management techniques can help reduce anxiety and depression, which worsen the symptoms of chemo brain.

Organize your living and work spaces. Choose specific places to store items, such as keys or glasses, and return them to the same spots.

Do just one thing at a time rather than multitasking

“Brain games,” such as Sudoku, crossword puzzles, or computer training programs won’t hurt, but probably won’t address the complex, real-world cognitive challenges you may face with chemo brain. Brain games are under study, so be cautious before purchasing any expensive brain-game program.

No medications have proved to work for chemo brain so far. Nevertheless, when these strategies are inadequate, it may be worth it to consider “stimulant” medications, such as Ritalin (methylphenidate) or Provigil (modafinil), in some situations.

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Last modified: October 3, 2017

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