Chemo brain

Overview

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.

Though chemo brain is a widely used term, the causes of concentration and memory problems aren't well-understood. It's likely that there are multiple causes.

No matter the cause, chemo brain can be a frustrating and debilitating side effect of cancer and its treatment. Researchers are working to understand the memory changes that people with cancer experience.

Symptoms

Signs and symptoms of chemo brain may include the following:

• Being unusually disorganized
• Confusion
• Difficulty concentrating
• Difficulty finding the right word
• Difficulty learning new skills
• Difficulty multitasking
• Feeling of mental fogginess
• Short attention span
• Short-term memory problems
• Taking longer than usual to complete routine tasks
• Trouble with verbal memory, such as remembering a conversation
• Trouble with visual memory, such as recalling an image or list of words

When to see a doctor

If you experience troubling memory or thinking problems, make an appointment with your doctor. Keep a journal of your signs and symptoms so that your doctor can better understand how your memory problems are affecting your everyday life.

Causes

There are many possible factors that might contribute to the signs and symptoms of memory problems in cancer survivors.

Cancer-related causes could include:

Cancer

• A cancer diagnosis can be quite stressful and it might lead to anxiety and depression, which can contribute to thinking and memory problems
• Certain cancers can produce chemicals that affect memory
• Cancers that begin in the brain or spread to the brain might cause changes in thinking

Cancer treatments

• Bone marrow transplant
• Chemotherapy
• Hormone therapy
• Immunotherapy
• Radiation therapy
• Surgery
• Targeted drug therapy

Complications of cancer treatment

• Anemia
• Fatigue
• Infection
• Menopause or other hormonal changes (caused by cancer treatment)
• Sleep problems
• Pain due to cancer treatments

Other causes

• Inherited susceptibility to chemo brain
• Medications for other cancer-related signs and symptoms, such as pain medications
• Other medical conditions, such as diabetes, thyroid problems, depression, anxiety and nutritional deficiency

Risk factors

Factors that may increase the risk of memory problems in cancer survivors include:

• Brain cancer
• Cancer that spreads (metastasizes) to the brain
• Higher doses of chemotherapy or radiation
• Radiation therapy to the brain
• Younger age at time of cancer diagnosis and treatment
• Increasing age

Complications

The severity and duration of the symptoms sometimes described as chemo brain differ from person to person. Most cancer survivors will return to work, but some will find tasks take extra concentration or time. Others may be unable to return to work.

If you experience severe memory or concentration problems that make it difficult to do your job, tell your doctor. You may be referred to an occupational therapist or a neuropsychologist, who can help you adjust to your current job or identify your strengths so that you may find a new job.

In rare cases, people with memory and concentration problems are unable to work and may consider applying for disability benefits. Ask your health care team for a referral to an oncology social worker or a similar professional who can help you understand your options.

Diagnosis

There are no tests to diagnose chemo brain. Cancer survivors who experience these symptoms often score within normal ranges on memory tests.

Your doctor may recommend blood tests, brain scans or other tests to rule out other causes of memory problems.

Treatment

Chemo brain treatment focuses on coping with symptoms. In most cases, cancer-related memory problems are temporary.

Because chemo brain symptoms and severity differ from person to person, your doctor can work with you to develop an individualized approach to coping.

Controlling conditions that contribute to memory problems

Cancer and cancer treatment can lead to other conditions, such as anemia, depression, sleep problems and early menopause, which may worsen memory problems. Controlling these other factors may make it easier to cope with these symptoms.

Managing chemo brain symptoms

A professional who specializes in diagnosing and treating conditions that affect memory and thinking (neuropsychologist) can create a plan to help you cope with chemo brain symptoms. Doctors sometimes refer to this as cognitive rehabilitation or cognitive remediation.

Learning to adapt and cope with memory changes may involve:

• Repetitive exercises to train your brain. Memory and thinking exercises may help your brain repair broken circuits that may contribute to chemo brain.
• Tracking and understanding what influences memory problems. Carefully tracking your memory problems may reveal ways to cope. For instance, if you become more easily distracted when you're hungry or tired, you could schedule difficult tasks that require extra concentration for the time of day when you feel your best.
• Using coping strategies. You may learn new ways of doing everyday tasks to help you concentrate. For instance, you may learn to take notes or make an outline of written material as you read. Or a therapist may help you learn ways of speaking that help you commit conversations to memory and then retrieve those memories later.
• Stress-relief techniques. Stressful situations can make memory problems more likely. And having memory problems can be stressful. To end the cycle, you may learn relaxation techniques. These techniques, such as progressive muscle relaxation or mindfulness practices, may help you identify stress and help you cope.

Medications

No medications have been approved to treat chemo brain. Medications approved for other conditions may be considered if you and your doctor agree they may offer some benefit.

Medications that are sometimes used in people with these symptoms include:

• Methylphenidate (Concerta, Ritalin, others), a drug used to treat attention-deficit/hyperactivity disorder (ADHD)
• Donepezil (Aricept), a drug used in people with Alzheimer's disease
• Modafinil (Provigil), a drug used in people with certain sleep disorders
• Memantine (Namenda), a drug used to improve memory in people with Alzheimer's disease, may help during radiation therapy to the brain

Lifestyle and home remedies

You can take steps to ease chemo brain symptoms on your own. For instance, try to:

• Control what you can about your working environment. If noise and commotion are contributing to your distraction, try to find a quiet place where you can concentrate. Consider earplugs or noise-cancelling headphones. Soft music may help drown out other noises.
• Prepare yourself for success. Before tackling a complicated task that requires concentration, take steps to ensure that you will have the best chance for success. Eat so you won't be distracted by hunger. Pick a time of day when you'll be the most alert. Get a good night's sleep. Have a plan so you know exactly what you'll need to do in order to complete your task.
• Stay organized. Use calendars or planners to keep on task. That way you won't spend time wondering if you're forgetting an appointment or an item on your to-do list. Write everything down in your planner. Make organization a priority at home and at work, too. Having an organized work space means you can spend more time on tasks that you need to accomplish.
• Clear your mind of distractions. When distracting thoughts pop up, write them down in your planner. Recording your thoughts will help to quickly clear them and ensure that you remember them later.
• Take frequent breaks. Divide your tasks into manageable portions and take a break each time you complete one part. Give yourself a short rest so that you'll be able to continue later.
• Exercise your brain. Try crossword puzzles or number games to exercise your brain. Take up a new hobby or master a new skill, such as learning to play a musical instrument or learning a language.
• Exercise your body. Moderate exercise, such as brisk walking, can help you cope with stress, fatigue and depression. All can contribute to memory problems. If you haven't been active lately, get the OK from your doctor first.

Alternative medicine

No alternative treatments have been found to prevent or cure chemo brain. If you're interested in trying alternative treatments for your symptoms, discuss the risks and benefits with your doctor.

Complementary and alternative treatments might help you cope with distress, which can contribute to thinking and memory problems in people with cancer.

Examples of treatments that might help include:

• Art therapy
• Exercise
• Meditation
• Music therapy
• Relaxation exercises
• Spirituality

Coping and support

Chemo brain symptoms can be frustrating and debilitating. With time, you'll find ways to adapt so that concentration will become easier and memory problems may fade. Until then, know that this is a common problem that's likely to improve with time. You might find it helpful to:

• Understand that memory problems happen to everyone. Despite your best strategies for dealing with your memory changes, you'll still have the occasional lapse. It happens to everyone. While you may have little control over the cancer-treatment-related memory changes, you can control other causes of memory lapses that are common to everyone, such as being overly tired, distracted or disorganized.
• Take time each day to relax. Stress can contribute to memory and concentration problems. Devote time each day to stress-relief activities, such as exercise, listening to music, meditation or writing in a journal.
• Be honest with others about your symptoms. Be open and honest with the people who are close to you about your chemo brain symptoms. Explain your symptoms and also suggest ways friends and family can help. For instance, you might ask a friend to remind you of plans by both phone and email.

Preparing for an appointment

If you're currently undergoing cancer treatment, talk to your oncologist about your signs and symptoms. If you've completed treatment, you might start by making an appointment with your family doctor. In some cases, you may be referred to a professional who specializes in helping people cope with memory difficulties (neuropsychologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready and what to expect from your doctor.

What you can do

• Keep a journal of your memory lapses. Describe the situations in which you experience memory problems. Note what you were doing and what type of difficulty you experienced.
• Make a list of all medications, as well as any vitamins or supplements that you're taking.
• Take a family member or friend along or bring a recorder. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot. Record the conversation with your doctor so you can listen to it later.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your visit. List your questions from most important to least important in case time runs out. For chemo brain, some basic questions to ask your doctor might include:

• What is likely causing my symptoms?
• How long do symptoms typically last?
• What kinds of tests can help determine whether my symptoms are caused by cancer treatment?
• Should I see a neuropsychologist? What will that cost, and will my insurance cover it?
• What is the best treatment for my symptoms?
• Are there things I can do on my own, in addition to the treatment you're suggesting, to help improve my memory problems?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?
• Should I plan for a follow-up visit?
• If I need brain radiation, can you do hippocampal-sparing radiation?
• Should I take memantine (Namenda) during brain radiation?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover points you want to address. Your doctor may ask:

• When did you first begin experiencing these symptoms?
• Have your symptoms been continuous or occasional?
• How do your symptoms affect your everyday life?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?