Chemo brain

Overview

Chemo brain is a common term people with cancer use to describe trouble with thinking and memory that can happen during and after cancer treatment. Chemo brain also can be called chemo fog, cancer-related cognitive impairment or cognitive dysfunction.

Chemo brain is a widely used term because this condition was first reported in people having chemotherapy treatments. But experts don't fully know the causes of these concentration and memory changes. There's likely more than one cause.

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

Symptoms

Chemo brain signs and symptoms include changes in memory and thinking.

Symptoms of chemo brain linked to memory may include:

• Trouble recalling what you've said to others.
• Trouble recalling what you've seen, such as images or lists of words.
• Trouble recalling what's happened recently, called short-term memory issues.

Symptoms of chemo brain linked to thinking may include:

• Trouble finding the right words.
• Trouble learning new skills.
• Trouble doing more than one thing at a time.
• Mental fog.
• Short attention span.
• Taking longer than usual to do routine tasks.

When to see a doctor

If you have trouble with memory or thinking, make an appointment with your healthcare professional. Keep a journal of your symptoms to help your healthcare professional know how your memory issues affect your life.

Causes

There are many causes of changes in memory and thinking in people with cancer. These chemo brain symptoms can be caused by the cancer, treatment for the cancer, complications of cancer treatment and other things.

Cancer-related causes may include:

Cancer

• The stress of a cancer diagnosis, which can cause worry and distress. These can add to issues with memory and thinking.
• Chemicals some cancers make that affect memory.
• Cancers that begin in the brain or spread to the brain may cause changes in thinking.

Cancer treatments

• Bone marrow transplant, also called stem cell transplant.
• Chemotherapy.
• Hormone therapy.
• Immunotherapy.
• Radiation therapy.
• Surgery.
• Targeted therapy.

Complications of cancer treatment

• Low levels of healthy red blood cells or hemoglobin needed to carry oxygen to the body's tissues, called anemia.
• Weakness and tiredness.
• Infection.
• Menopause or other hormonal changes caused by cancer treatment.
• Sleep issues.
• Pain due to cancer treatments.

Other causes

• Some people may be more likely to get chemo brain based on genetic makeup.
• Medicines for other cancer-related symptoms, such as pain medicines.
• Other medical conditions, such as diabetes, thyroid conditions, depression, anxiety and not getting enough nutrients.

Risk factors

Factors that may increase the risk of chemo brain and memory changes in people with cancer include:

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

Complications

Some people with chemo brain have thinking and memory changes that affect their ability to work. Most people with cancer can return to work at least part-time. But some may find that tasks now take extra focus or time. Others may not be able to return to work.

If you have trouble focusing on what you need to do for your job, tell your healthcare professional. Your healthcare professional may send you to a specialist who can help, such as an occupational therapist. This person can help find ways to make it easier to do your job.

Rarely, people with chemo brain can't work. Ask your healthcare team to refer you to a social worker. This person may help you find programs that support people who can't work because of a health condition.

Diagnosis

There are no tests to diagnose chemo brain. People with cancer who have these symptoms often score within typical ranges on memory tests.

A healthcare professional makes a chemo brain diagnosis based on your symptoms. Your healthcare professional may suggest blood tests, brain scans or other tests to rule out other causes of your symptoms.

Treatment

Chemo brain treatment focuses on helping you cope with symptoms. Often, cancer-related memory changes clear up with time. Your healthcare team can help you find a way to cope with your symptoms.

Managing conditions that add to troubles with memory

Cancer and cancer treatment can lead to other conditions, such as anemia, depression, sleep issues and early menopause. These can make thinking and memory changes worse. Managing these other conditions may make it easier to cope with the symptoms of chemo brain.

Managing chemo brain symptoms

Treatment for chemo brain often involves finding ways to cope with the thinking and memory changes. This treatment may be called cognitive rehabilitation or cognitive remediation. It's often done by a healthcare professional who specializes in diagnosing and treating conditions that affect memory. This health professional is called a neuropsychologist.

Learning to cope with memory changes may involve:

• Brain-training exercises. Memory and thinking exercises may help your brain repair broken links that may add to chemo brain.
• Tracking your memory troubles. Knowing what adds to your trouble with memory may show you ways to cope. For instance, do you have more trouble thinking when you're hungry or tired? Maybe you can plan to do tough tasks at the time of day when you feel your best.
• Finding ways to cope. Learning new ways of doing tasks may help you focus. For instance, it may help to take notes or make an outline of what you read. Or a therapist may help you learn ways of speaking that help you remember what you said.
• Relieving stress. Stress can make memory changes worse. And having memory changes can be stressful. It may help you to learn ways to relax. You might do progressive muscle relaxation, in which you tense and relax muscles throughout your body. Or you might learn to focus on what's around you, such as sights, smells and sounds. This is called mindfulness. These practices may help you cope with stress.

Medicines

No medicines are approved to treat chemo brain. There may be medicines approved for other conditions that you and your healthcare team agree might help.

Medicines people with chemo brain symptoms sometimes use include:

• Methylphenidate (Concerta, Ritalin, others). This medicine is most often used for attention-deficit/hyperactivity disorder, also called ADHD.
• Donepezil (Aricept, Adlarity). This medicine is most often used for Alzheimer's disease.
• Modafinil (Provigil). This medicine is most often used for some sleep conditions.
• Memantine (Namenda). This medicine is most often used for Alzheimer's disease. It also may help people who get radiation therapy to the brain.

Lifestyle and home remedies

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

Manage what you can at home and work

If noise is adding to your trouble thinking, try to find a quiet place where you can focus. Try earplugs or noise-canceling headphones. Soft music may help drown out other noises.

Prepare for success

Before doing a task that needs your focus, take steps to make sure you do your best. Eat so you won't be hungry. Pick a time of day when you'll be the most alert. Get a good night's sleep. Have a plan so you know what you need to do to complete your task.

Stay organized

Use calendars or planners to keep on task. Write down every appointment and the things you need to do. Organize your home and workspace to make tasks easier.

Clear your mind of thoughts that distract you

When these thoughts come up, write them down in your planner. This may help you get them off your mind. And it may help you recall them later if you need to.

Take breaks often

Divide your tasks into smaller parts. Take a break each time you complete one part. Take a short rest to help you do more later.

Exercise your brain

Try crossword puzzles or number games to exercise your brain. Take up a new hobby or learn a new skill, such as playing a musical instrument or speaking a new language.

Exercise your body

Moderate exercise, such as brisk walking, can help with stress. It also can boost energy levels and improve mood. If you haven't been active lately, get the OK from your healthcare team before you start exercising.

Alternative medicine

Research hasn't proved that any alternative treatments prevent or cure chemo brain. If you're interested in trying alternative treatments for your symptoms, discuss the pros and cons with your healthcare team.

Complementary and alternative treatments might help you cope with distress, which can add 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 hard to cope with. With time, you'll likely find ways to make focusing easier. Until then, know that this is a common problem that's likely to improve with time. You might find it helpful to:

• Know that memory issues happen to everyone. Despite using your best ways for dealing with your memory changes, you'll still forget things sometimes. Everyone does. There may be little you can do about memory changes linked to cancer. But you can manage other causes of forgetting that are common to everyone. These include being overly tired, distracted or not organized.
• Take time each day to relax. Stress can add to memory troubles. Do stress-relief activities every day. You might exercise, listen to music, meditate or write in a journal.
• Tell others about your symptoms. Be open and honest with people close to you about your chemo brain symptoms. Explain your symptoms. 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 having cancer treatment, talk with your cancer care team about your chemo brain symptoms. If you've finished treatment, you might start by making an appointment with your main healthcare professional. Your healthcare professional may send you to a specialist. This might be a healthcare professional who diagnoses and treats conditions that affect memory, called a neuropsychologist.

Here's some information to help you get ready for your appointment.

What you can do

• Keep a journal of your memory lapses. Describe the times you have memory troubles. Note what you were doing and what type of trouble you had. Note when you first noticed symptoms.
• List all medicines, vitamins and supplements you take, including dosages.
• Take a family member or friend along or bring a recorder. Taking someone with you or using a recorder can help you remember what you talk about with your healthcare professional.
• Write down questions to ask your healthcare professional.

For chemo brain, list questions such as:

• What is likely causing my symptoms?
• How long do symptoms last?
• What tests can show whether my cancer treatment caused my symptoms?
• What is the best treatment for my symptoms?
• What can I do to help improve my memory?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional may ask you:

• Do your symptoms come and go or do they stay with you?
• How do your symptoms affect your everyday life?
• What, if anything, seems to make your symptoms better?
• What, if anything, seems to make your symptoms worse?