What is chemo brain?

Chemo brain” is a common term used by cancer survivors to describe the thinking and memory problems that can occur after cancer treatment. For many years now, cancer survivors have worried, joked and been frustrated by the mental cloudiness that sometimes occurs before, during, and after cancer treatment. Patients and doctors have been aware of  “chemo brain” for some time, but only recently, have studies been done to explain it.

Doctors know that radiation treatment to the brain can cause thinking and memory problems. Recently, it has been found that the use of chemotherapy is linked to some of the same kinds of problems. Research indicates that some cancer drugs can cause changes in the brain but it also shows that chemotherapy and radiation are not the only factors that can cause problems with thinking and memory in people with cancer.

Although the brain usually recovers over time, the vague, yet distressing mental changes, cancer patients notice are real and not imaginary. These symptoms might last for a short period of time, or they might continue for many years.

Here are a few examples of what patients call, “chemo brain”:

• Forgetting things that they usually have no trouble recalling (memory lapses).

• Difficulties with concentration span  (they cannot focus on what they are doing, have a short attention span, or may “space out”).

• Problems with remembering details like names, dates, and important events.

• Trouble multi-tasking, like answering the phone while cooking, (they are not able to do more than one thing at a time).

• Taking longer to complete tasks (disorganised, slower thinking and processing).

• Trouble remembering common words (unable to find the right words to finish a sentence).

Doctors and researchers refer to  “chemo brain” as mild cognitive impairment.  This condition is characterised by an inability to remember certain things and having trouble completing tasks, or learning new skills.

For someone who has lost some brain function, even short-term problems with thinking and memory may be scary. Some people may have difficulty remembering simple things, like closing doors or turning off lights. Other people may notice that their brain does not function as well as it did before. These kinds of neurological complications may lead to problems at work and at home. People who notice problems in their thinking patterns may feel even more upset if their doctors blame these symptoms on aging or act like it’s nothing to worry about. It is distressing to wonder if you will ever be able to do your job again, or if you will get lost on the way to a familiar place.

Studies suggest that there may be more than one cause of “chemo brain”, especially for the short-term symptoms. Some people with cancer have real neurological problems even though they have not had chemotherapy.  Other patients notice problems when undergoing hormone treatments, such as estrogen blockers or androgen deprivation therapy (treatments to lower testosterone levels).  Some people may experience problems start after surgery. Along with chemotherapy, many different problems can worsen brain function.

For instance, neurological problems could be caused or worsened by any one or any combination of these factors:

• The cancer itself.

• Other drugs used as part of treatment (such as steroids, anti-nausea, drugs used during surgery or pain medication).

• Low blood counts.

• Problems with sleeping.

• Infection.

• Tiredness (fatigue).

• Hormonal changes or hormone treatments.

• Other illnesses, such as diabetes or high blood pressure.

• Nutritional deficiencies.

• Patient’s age.

• Depression.

• Stress, anxiety or other emotional pressure.

Most of these factors may cause short-term problems and get better as the underlying problem is treated or goes away. A few of these problems, such as depression, can cause long-lasting neurological problems unless the cause is treated.

There is no known way to prevent “chemo brain”. For some people, treating their cancer will result in difficulties associated with thinking, memory, planning and word finding.

Experts have been studying memory for a long time. There are many resources that might help you sharpen your mental abilities and manage the problems that might come with “chemo brain”. Some things that you can do are:

• Use a detailed daily planner. Keeping everything in one place makes it easier to find the reminders you may need. Using a planner can help keep track of appointments and schedules, “to do” lists, important dates, websites, phone numbers and addresses, meeting notes and even movies you would like to see or books you would like to read.

• Exercise your brain. Take a class, do word puzzles or learn a new language.

• Get enough rest and sleep.

• Exercise your body. Regular physical activity is not only good for your body, but also improves your mood, makes you feel more alert and decreases tiredness (fatigue).

• Eat your vegetables. Studies have shown that eating more vegetables is linked to maintaining brain power as you age.

• Set up and follow routines. Pick a certain place for commonly lost objects and put them there each time. Try to keep the same daily schedule.

• Do not try to multi-task. Focus on one thing at a time.

• Ask for help when you need it. Friends and loved ones can help with daily tasks to cut down on distractions and help you save mental energy.

• Keep track of your memory problems. Keep a diary of when you notice problems and the events that are going on at the time. Medicines taken, time of day, and the situation you are in might help you figure out what affects your memory. Having a record of when the problems are most noticeable can also help you prepare. You will know to avoid planning important conversations or appointments during those times. This record will also be useful when you talk to your doctor about these problems.

Try not to focus on how much these symptoms bother you. Accepting the problem will help you deal with it. As many patients have noted, being able to laugh about things you cannot control can help you cope. And remember, you probably notice your problems much more than others do. Sometimes, we all have to laugh about forgetting to take the grocery list with us to the store.

Written by Dr Owen Nosworthy