What Causes It and What You Can Do about It
by Arash Asher, MD
Until recently, the cognitive changes brought on by cancer treatment – often called chemo brain or chemo fog – were brushed under the rug. Many physicians believed they were simply a result of anxiety or distress and, therefore, not a real medical concern. We are now learning, however, that up to 75 percent of people treated for cancer do experience some form of cognitive symptoms due to the disease and its treatment.
Although chemo brain symptoms can vary quite a bit among individuals, some commonly reported cognitive effects include
- Word-finding difficulties
- An inability to multitask
- Short-term memory problems
- Difficulty concentrating or a short attention span
The truth is that chemo brain may not be the best term to describe cancer-related cognitive effects. Historically, it was assumed that chemotherapy was the cause of the problem, hence the term chemo brain. However, recent research suggests that, although chemotherapy may be a risk factor for developing these problems, many other factors may play a significant role. These include
- Radiation therapy
- Hormonal changes from antiestrogen drugs used to treat some types of breast cancer or androgen-suppression drugs used in treating prostate cancer
- Poor sleep
- Side effects from other medications that are often given to people undergoing treatment for cancer, including pain medications, some anti-nausea medications, and corticosteroids
- Severe stress, anxiety, or depression
Up to 75 percent of people treated for cancer experience some form of mild cognitive impairment.
In addition, many scientists now believe that it may not be the chemotherapy itself that causes cognitive changes (as most chemotherapy drugs can’t readily infiltrate the brain tissue). Instead, they hypothesize that cognitive changes are a result of the body’s reaction to the chemotherapy. Think about, for example, how you feel when you have the flu. Most people feel tired, a bit blue, achy … and foggy.
No one wants to study for a midterm when they are down with the flu. And the reason isn’t the flu virus itself, but rather the body’s response to the flu virus. When you have the flu, your body releases chemicals called inflammatory chemicals, or cytokines, that make you feel tired, achy, and foggy. It’s your body’s way of forcing you to rest.
In terms of how this relates to chemotherapy, one prevailing theory is that your body treats the chemo drugs like it would any foreign bug. Just like when you have the flu, when you undergo chemotherapy, your body produces cytokines. These chemicals make you feel tired and, you guessed it, foggy.
How to Cope
Whatever the cause of cancer-related cognitive changes, here are a few things you can do to manage them.
- Bide your time. Studies show that around 75 percent of survivors return to pre-cancer cognitive functioning within six to twelve months of finishing active treatment and require no intervention.
- Exercise. Recent evidence suggests that moderate aerobic exercise during or after chemotherapy can help reduce cancer-related cognitive symptoms. Exercise can also help combat fatigue and improve your mood, which both can affect cognitive functioning.
- Manage depression and anxiety. There is a tremendous amount of overlap between the symptoms of depression and anxiety and the symptoms of chemo brain. Talk to your doctor about ways to manage your anxiety and depression. Professional therapy, depression medications, and mind-body exercises can all be useful.
- Talk to your doctor. In order to rule out other possible causes of cognitive changes, your doctor should review all your medications to make sure none of them are contributing to your cognitive symptoms. You should also have some basic lab work done (such as thyroid testing and blood counts) to check for other medical conditions that can affect cognitive functioning.
- Sleep. Make sure you are doing what you can to guard your sleep. The correlative relationship between inadequate or poor quality sleep and cognitive challenges can’t be emphasized enough.
- Get organized. Keeping your workspace and living area more organized may help you better keep track of things. For example, choose specific places to store items such as your keys or glasses, and return them to the same spot.
- Don’t multitask. Try to focus on doing one thing at a time.
- Consider cognitive rehabilitation. Talk to your doctor about the possibility of using cognitive rehabilitation to help you manage your symptoms. Although more research is needed, some newer evidence does point to the benefits of cognitive rehabilitation programs (where available) for cancer survivors experiencing cancer-related cognitive dysfunction.
Dr. Arash Asher is the director of Cancer Survivorship & Rehabilitation at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles, CA. Dr. Asher specializes in the nonpharmacologic management of pain, cancer-related fatigue, cognitive dysfunction, and neuropathy in cancer survivors.
This article was published in Coping® with Cancer magazine, May/June 2016.