I'm writing this after searching for a pan of carrots I was preparing - and finding it in my fridge! It made me think of how easily we can get muddled when doing several things at once, and our concentration lapses. If you’re on treatment, or recently finished, and you find you’re more forgetful, and unable to concentrate, you’re not alone.
What is meant by 'chemo brain?
A side effect of cancer treatment which sometimes gets overlooked, yet can temporarily affect many people, is so called ‘Chemo brain’. It’s a symptom often spoken about anecdotally in clinics, and now a growing body of research is backing it up. The evidence suggests that there can be many causes, not necessarily just chemotherapy, including some of the hormone therapies used in breast and prostate cancer, for example. There may also be side effects of other medications, being anaemic, or fatigued - all of which may compound the symptoms.
Some people also think that having cancer itself, the trauma, of diagnosis and living with a life changing or limiting illness, is an additional factor affecting the way we think and function cognitively. Anxiety, depression and aging can add to the feeling of confusion, and the inability to focus or concentrate. For those of you returning to work after cancer treatment, it may feel more noticeable (to you) that complex tasks take more thinking through, and processing information may take longer. Fortunately, for most people, it is only temporary.
Chemo brain is defined as ‘a common term used by cancer survivors to describe thinking and memory problems that can occur after cancer treatment. Chemo brain can also be called chemo fog, chemotherapy-related cognitive impairment or cognitive dysfunction.
Symptoms of chemo brain
Cancer Research UK in their webpage section on 'chemo brain', gives a list of symptoms that may be experienced:-
Memory loss – forgetting things that you normally remember
Difficulty thinking of the right word for a particular object
Difficulty following the flow of a conversation
Trouble concentrating or focusing on one thing
Difficulty doing more than one thing at a time (multi tasking)
More difficulty doing things you used to do easily, such as adding up in your head
Fatigue (tiredness and lack of energy)
Confusion
Mental fogginess
Tim Ahles, a behavioural psychologist, spoke recently at the 2016 Cancer Survivorship Symposium (see ACSO newsreel video - linked at bottom of page). He mentions that most research in this area has been longitudinal studies in women with breast cancer, and that 75% - 80% of women treated for breast cancer will regain their cognitive function after treatment has finished (although this may take some months).
For a small subgroup, approximately 20 – 25%, may have long term effects, lasting longer than a year and perhaps up to ten or twenty years post treatment. Alarming as this may sound, the changes are generally relatively minor, and may only be noticed by you yourself…but nonetheless can be frustrating.
What can be done to treat ‘chemo brain’
There is early and ongoing research research into a number of treatments.. These include Erythropoietin (EPO) which can increase haemoglobin levels, in the blood. Aspirin, a blood thinner, is also used – both these drugs may work by increasing blood flow and oxygen levels to the brain. The third drug, Methylphenidate, normally used for chronic fatigue syndrome, daytime drowsiness and attention deficit disorder, may have its uses. The use of 'cognitive rehabilitation' (practicing repetitive and more mentally challenging tasks) is proving helping, as are the benefits of daily exercise.
What can I do to help myself?
- Explain to friends, family and work colleagues that your treatment has caused some temporary memory problems, so to bear with you as things recover.
- Research that exercise benefits us in many ways, and this includes helping regain cognitive function, as well as other health benefits. Swimming, walking, gardening can all help…it doesn’t have to be an organised sport or physical activity..
- Eating a healthy diet, including more vegetables, fruit and oily fish - and resting and relaxation when you can.
- Brain exercises – crosswords, soduku, word games etc, can help the brain regain cognitive skills.
- Writing lists can be helpful, and leaving objects in the same place every time. (Keys in handbag/key rack, phone on breakfast bar, etc).
- Carry a notebook, or use your mobile phone to log things down – places you need to be, people’s names etc.
- Keep a note of times when your memory is worse...and try and avoid those times for taking on challenging tasks.
- Multi-tasking can be a problem sometimes, so focus on one specific job at a time. Don’t take on too big a mental challenge job wise to start with, either – ease in gently.
- Be ready for the next day, by getting things ready the night before.
- It’s worth having a timer, in the kitchen, to remind you when things are cooked. Also using alarm reminders from your mobile or tablet for appointments, meetings etc.
Talk to others
- If your memory/cognitive problems are a concern, do mention it to your specialist nurse, GP and/or consultant – as they can check that nothing else is contributing to the problem. It could be other medications, whether you’re feeling anxious, depressed or something else going on with your health – so always wise to get it checked out.
- Talk with other people who are on or have had cancer treatment, in clinic or treatment centre, a local support group, or somewhere like your nearest Maggie’s Centre. Here you’ll meet people who understand what you’re feeling, and you can join relaxation classes, nutrition workshops, and stress management classes, which can help you emotionally and cognitively.
- Using gentle humour to acknowledge the mind lapses that occur – most of us can identify with the getting to the top of the stairs and wondering why we’re up there…(and gone back to downstairs, only to remember what it was!). Friends and family can help and rally round, if they know you may be more forgetful at times.
Finally, build on your strengths…you’re still you…the brain has taken a ‘hit’ during treatment, but most times will recover.
You’re very welcome to drop into one of our Maggie’s Centres or join in our online discussions for more information, discussion and support,
Warm wishes
Sue
Updated July 2020
Resources
Chemo brain - Cancer Research UK
Chemo brain - American Cancer Society
Chemo brain - Macmillan Cancer Support
Tim A. Ahles, PhD, on Neurocognitive Late Effects (video) - 2016 Cancer Survivorship Symposium
Cognitive dysfunction - chemo brain - Oncolink
Chemo brain (cancer related cognitive impairment) - Lymphoma Association
Understanding ‘chemobrain’ and cognitive impairment after cancer treatment - National Cancer Institute